Can opioid usage lead to pancreatic cancer? Study suggests drug consumption may be a risk factor
Opioid use may be a risk factor contributing to the increasing incidence of pancreatic cancer, according to researchers from Rush University Medical Center, US. They have found that taking opioids may increase a person’s risk of developing pancreatic cancer.
The findings come even as opioid misuse and overdose have evolved into a public health crisis in the US. “Our results indicate opioid usage, estimated by opioid death rates may partially explain the uptrend of pancreatic cancer rates in the US at the national as well as the state levels over time. These findings suggest that opioids use may be a novel risk factor for pancreatic cancer, a finding that needs further studies,” suggest authors.
The opioid crisis
Opioids are a class of drugs used to reduce pain. After decreasing from 2017 to 2018, provisional data indicate that drug overdose deaths increased in 2019, driven by opioid-involved and stimulant-involved overdose deaths. According to the US Centers for Disease Control and Prevention (CDC), more than 80% of overdose deaths involved one or more opioids, and illicitly manufactured fentanyls were involved in three of four opioid-involved overdose deaths.
Pancreatic cancer is currently the third leading cause of cancer-related death in the US. In 2020, the American Cancer Society estimated that about 57,600 people (30,400 men and 27,200 women) will be diagnosed with pancreatic cancer, while about 47,050 people (24,640 men and 22,410 women) will die of pancreatic cancer. Overall, pancreatic cancer accounts for about 3% of all cancers in the US, and about 7% of all cancer deaths.
“Pancreatic cancer rates are increasing in the US. Opioids have been shown to have a harmful effect on multiple types of cancer with recent data suggesting opium use as a possible risk factor for pancreatic cancer in West Central Asia. Population-based studies have suggested opium use to increase the risk of pancreatic cancer in a dose dependent manner. While opium use is not a common recreational habit in the US, opioid use has been rising remarkably over the past decade,” write researchers in the current study, which has been published in the journal PLOS One.
The findings
The team aimed to examine the possible association between the pattern of opioid use and the changes in the rates of pancreatic cancer between 1999-2016. Using the CDC’s ‘Wonder’ online data, which was obtained from the Vital Statistics Cooperative Program, they extracted the opioid death rate as a surrogate for prescription and illicit opioid use. Incidence of pancreatic cancer was retrieved from the CDC’s online database gathered from the US Cancer Statistics Working Group. The authors also extracted the pattern of the lifestyle and behavioral factors that over time could potentially affect the risk of pancreatic cancer.
The investigators analyzed whether the trend in opioid usage could explain increasing pancreatic cancer diagnoses at the national and state levels over time after correcting for the potential confounding factors. They found that both pancreatic cancer and opioid death rates rose over time at the national and state levels. A prior state’s opioid death rate significantly predicted the trend in the incidence of pancreatic cancer years after and had a significant effect on the estimated annual change in the rate of this cancer.
“From 1999-2016, there were 700,300 incident cases of pancreatic cancer in the US. Concurrently, 351,630 opioid overdose deaths occurred during this same period. The pancreatic cancer incidence rate in the average state increased at an unadjusted rate of 0.137 percentage points per year from 1999 to 2016. Among contributing factors evaluated at a state level, the opioid death rate increased significantly over the study period,” reveals analysis.
According to the authors, the data suggests a link between opioid consumption and the risk of pancreatic cancer. The next step to directly establish the role of opioids as a novel risk factor for pancreatic cancer is to conduct large population-based studies or longitudinal datasets that reliably register long-term outcomes in opioid users, they explain.
Findings from the current study, once confirmed by the individual-level data on opioid consumption and risk of pancreatic cancer, could have direct clinical relevance by considering alternative pain control approaches in these patients, say experts. “Once confirmed, implications of the opioids on pancreatic cancer development are clinically significant given the widespread opioid usage in the country. Furthermore, opioids are widely used for pain management in pancreatitis, an established precursor to pancreatic cancer, as well as in cancer itself,” they write.
The team proposes to investigate possible mechanisms that may link opioid use to the development and/or progression of pancreatic cancer. “Consistent with the current findings, a recent post hoc analysis of two randomized controlled trials of patients with advanced cancers (including pancreatic cancer), revealed that those treated frequently with an opioid antagonist had significantly improved overall survival compared to placebo,” the findings suggest.
Dr Faraz Bishehsari, the corresponding author of the report, emphasizes that their “mechanistic studies” could provide further insights on the “pathways that opioid could potentially impact the progression of cancer.”