ABSTRACT
Survival from pancreatic cancer remains poor. Conventional treatment has resulted in only marginal improvements in survival compared with survival in the previous several decades. Thus, considerable interest has emerged regarding the potential use of common pharmaceutical agents as chemopreventative and chemotherapeutic options. Aspirin, metformin, statins, β-blockers, and bisphosphonates have biologically plausible mechanisms to inhibit pancreatic neoplasia, whereas dipeptidyl-peptidase 4 inhibitors may promote it. Regardless, real-world epidemiological data remain inconclusive. This review examines the hypotheses, evidence, and current state of the literature for each of these medications and their potential roles in the prevention and treatment of pancreatic cancer.
Subject(s)
Adenocarcinoma , Aspirin , Dipeptidyl-Peptidase IV Inhibitors , Diphosphonates , Epidemiology , Hydroxymethylglutaryl-CoA Reductase Inhibitors , Metformin , Pancreas , Pancreatic NeoplasmsABSTRACT
BACKGROUND Only a few studies in Western countries have investigated the association between gastroesophageal reflux disease [GERD] and mortality at the general population level and they have shown mixed results
This study investigated the association between GERD symptoms and overall and cause-specific mortality in a large prospective population-based study in Golestan Province, Iran
METHODS: Baseline data on frequency, onset time, and patient-perceived severity of GERD symptoms were available for 50001 participants in the Golestan Cohort Study [GCS]
We identified 3107 deaths [including 1146 circulatory and 470 cancer-related] with an average follow-up of 6.4 years and calculated hazard ratios [HR] and 95% confidence intervals [CI] adjusted for multiple potential confounders
RESULTS: Severe daily symptoms [defined as symptoms interfering with daily work or causing nighttime awakenings on a daily bases, reported by 4.3% of participants] were associated with cancer mortality [HR 1.48, 95% CI: 1.04-2.05]
This increase was too small to noticeably affect overall mortality
Mortality was not associated with onset time or frequency of GERD and was not increased with mild to moderate symptoms
CONCLUSION: We have observed an association with GERD and increased cancer mortality in a small group of individuals that had severe symptoms. Most patients with mild to moderate GERD can be re-assured that their symptoms are not associated with increased mortality
ABSTRACT
The Gastro-Esophageal Malignancies in Northern Iran [GEMINI] research project is an example of recent progress in health research in Iran. The original aim of this project was to identify etiologic factors and prevention measures for upper gastrointestinal cancers in Northern provinces of Iran, but its achievements have gone much beyond this initial goal. GEMINI consists of several projects including cancer registries, pilot studies, case-control studies, and the Golestan Cohort Study. GEMINI has been conducted through extensive collaborations between the Digestive Disease Research Center of Tehran University of Medical Sciences with other domestic and international health organizations. The achievements of GEMINI include producing new knowledge, introducing new research methods, developing and expanding health research and health care infrastructures, investing in human resources, and increasing the awareness and knowledge of policy makers and officials at all levels about the importance of chronic diseases in Iran's health priorities. The success of GEMINI reveals the feasibility of large-scale health research studies in developing countries and serves as a successful model not only for health research in Iran, but also for similar research studies in other developing nations