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Serum Immunoglobulin E and Risk of Pancreatic Cancer in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial

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Serum Immunoglobulin E and Risk of Pancreatic Cancer in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial Published OnlineFirst April 9, 2014; DOI: 10.1158/1055-9965.EPI-13-1359 Cancer Epidemiology, Short Communication Biomarkers & Prevention Serum Immunoglobulin E and Risk of Pancreatic Cancer in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial Sara H. Olson1, Meier Hsu1, Joseph L. Wiemels5, Paige M. Bracci5, Mi Zhou5, Joseph Patoka5, William R. Reisacher4, Julie Wang3, Robert C. Kurtz2, Debra T. Silverman6, and Rachael Z. Stolzenberg-Solomon7 Abstract Epidemiologic studies have consistently found that self-reported allergies are associated with reduced risk of pancreatic cancer. Our aim was to prospectively assess the relationship between serum immunoglobulin E (IgE), a marker of allergy, and risk. This nested case–control study within the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO) included subjects enrolled in 1994 to 2001 and followed through 2010. There were 283 cases of pancreatic cancer and 544 controls matched on age, gender, race, and calendar date of blood draw. Using the ImmunoCAP system, we measured total IgE (normal, borderline, elevated), IgE to respiratory allergens, and IgE to food allergens (negative or positive) in serum collected at baseline. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using conditional logistic regression. We assessed interactions with age, gender, smoking, body mass index, and time between randomization and case diagnosis. Overall, there was no association between the IgE measures and risk. We found a statistically significant interaction by baseline age: in those aged 65 years, elevated risks were observed for borderline total IgE (OR, 1.43; 95% CI, 0.88–2.32) and elevated total IgE (OR, 1.98; 95% CI, 1.16–3.37) and positive IgE to food allergens (OR, 2.83; 95% CI, 1.29–6.20); among participants <65 years, ORs were <1. Other interactions were not statistically significant. The reduced risk of pancreatic cancer associated with self-reported allergies is not reflected in serum IgE. Cancer Epidemiol Biomarkers Prev; 23(7); 1414–20. Ó2014 AACR. Introduction of total IgE and specific IgE to respiratory allergens would Pancreatic cancer is a deadly disease, with 5-year sur- be inversely associated with risk of pancreatic cancer; we vival only 6% (1). A consistent finding in epidemiologic did not have a specific hypothesis about IgE to food studies is reduced risk associated with self-reported aller- allergens. Tests of total and specific IgE may point toward gies (2–5). Very little is known about the biologic basis of a functional allergy pathway that cannot be inferred from this association, which is found in other cancers as well (5). self-reported allergy. We tested this hypothesis in the For pancreatic cancer, evidence of reduced risk is most National Cancer Institute’s prospective Prostate, Lung, consistent for respiratory allergies, whereas asthma is not Colorectal, and Ovarian Cancer Screening Trial (PLCO). associated with risk. Although few studies have investi- gated food allergies, there is little evidence of an associ- Materials and Methods ation with risk (3). Study population Individuals with allergies are characterized by high We used a nested case–control design within PLCO, a levels of serum immunoglobulin E (IgE), both total IgE randomized trial investigating the effects of screening for and allergen-specific IgE. We hypothesized that measures prostate, lung, colorectal, and ovarian cancers (6). From 1994 to 2001, >150,000 men and women ages 55 to 74 years Authors' Affiliations: 1Department of Epidemiology and Biostatistics; at entry were randomized at 10 screening centers to 2Department of Medicine, Memorial Sloan Kettering Cancer Center; 3Divi- receive screening or usual care. Participants were eligible sion of Pediatric Allergy and Immunology, Mt. Sinai Medical Center; if they were not currently undergoing treatment for any 4Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York, New York; 5Department of Epidemiology and cancer (except nonmelanoma skin cancer) and had not Biostatistics, School of Medicine, University of California, San Francisco, been diagnosed with one of the cancers under study. San Francisco, California; 6Occupational and Environmental Epidemiology Branch; and 7Branch of Nutritional Epidemiology, Division of Cancer Participants completed baseline questionnaires on back- Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland ground characteristics and provided a blood sample. Corresponding Author: Sara H. Olson, 307 East 63rd Street, New York, Questions on allergies were not included. NY 10065. Phone: 646-735-8158; Fax: 646-735-0010; E-mail: Cases had confirmed incident primary pancreatic ade- [email protected] nocarcinomas diagnosed from 1994 to 2010 (ICDO3 codes doi: 10.1158/1055-9965.EPI-13-1359 C250–C259, excluding histology codes for endocrine neo- Ó2014 American Association for Cancer Research. plasms). They were identified by an annual mail survey to 1414 Cancer Epidemiol Biomarkers Prev; 23(7) July 2014 Downloaded from cebp.aacrjournals.org on September 27, 2021. © 2014 American Association for Cancer Research. Published OnlineFirst April 9, 2014; DOI: 10.1158/1055-9965.EPI-13-1359 Serum IgE and Risk of Pancreatic Cancer participants or next of kin and search of cancer registries used to estimate odds ratios (OR) and 95% confidence and death certificates. intervals (CI). In the controls, we determined the associa- A total of 295 pancreatic cancer cases were identified. tions of total and specific IgE measures with demographic Controls unaffected by pancreatic cancer were alive in the characteristics, design factors, and risk factors, using x2 year of the matched cases’ diagnosis and were matched to tests to compare groups. For total IgE, results were log each case in a 2:1 ratio on age at randomization (<60, 60–64, transformed to adjust for skewness in order to determine 65–69, 70), year of birth (in 5-year groups from 1920– the geometric mean and SD and to assess the linear 1924 to 1945–1949), gender, race, and calendar date of association of total IgE with risk. To identify potential blood draw (in 2-month groups, beginning with January/ confounding factors, we entered each of the demographic, February). Twelve cases and 26 controls were excluded design, and risk factors individually into the conditional from analysis because they had missing information on all logistic models and included those factors that changed 3 IgE measures; in addition, 20 more controls were exclud- the risk estimate by 5%. Confounders included in final ed because their matched cases were excluded, resulting models were cigarette smoking for total IgE and IgE to in a total of 283 cases and 544 matched controls. respiratory allergens and study center for IgE to food The PLCO study was approved by the institutional allergens. review boards of the screening centers and the National We explored whether the risk of pancreatic cancer Cancer Institute. This analysis was reviewed by the insti- associated with serum IgE varied by age at baseline tutional review board at Memorial Sloan Kettering Cancer (<65 or 65), gender, smoking history (never smokers Center. and former smokers who quit 15 years ago; current smokers and former smokers who quit <15 years ago), Measurement of total and allergen-specific IgE and BMI (dichotomized at the median value, 26.55). Stra- Blood samples were collected at study entry, processed tum-specific ORs and 95% CIs were estimated from mul- within 2 hours, and stored at À70C. IgE measures were tivariable conditional logistic regression models with undertaken in the Laboratory for Molecular Epidemiolo- cross-product terms composed of the IgE measure and gy at the University of California San Francisco using the the potential effect modifier variable. To determine ImmunoCAP Fluorescent Enzyme Immunoassay system whether the association between IgE and risk varied by (Thermo Fisher Scientific; ref. 7). ImmunoCAP is a fluo- the length of time between randomization and diagnosis, rescent assay in which the solid phase is a flexible, hydro- we categorized cases and matched controls into groups of phobic cellulose polymer to which allergen has been 0 to 5, 6 to 9, and 10 to 15 years between randomization and covalently linked. The system has a very high binding diagnosis and analyzed this association using conditional capacity and minimal nonspecific binding. For allergen- logistic regression with interaction terms. specific IgE, ImmunoCAP’s Phadiatop combines specific All statistical analyses were performed in SAS version respiratory allergens that identify about 97% of indivi- 9.2 (SAS Institute Inc.). duals with respiratory allergies in the United States; information on the specific allergens included is not Results provided. The food panel includes peanuts, tree nuts, Characteristics of cases and controls are shown in Table shellfish, milk, egg, and codfish. Laboratory technicians 1. Slightly more than half the cases and controls were aged were blinded to case–control status. We categorized the 65 years at baseline. Sixty-two percent were men, 90% IgE measures using standard cut points: for total IgE, were white, and 38% were college graduates. Cases were normal (<25 kU/L), borderline (25–100 kU/L), and ele- more likely to be current or recent cigarette smokers and vated (>100 kU/L); for IgE for respiratory allergens and more likely to report having diabetes. food allergens, negative (<0.35 kU/L) or positive (i.e., For total IgE, the distribution of results in controls was detectable; 0.35 kU/L). For total IgE, we additionally as follows: normal, 41% (n ¼ 224); borderline, 35% (n ¼ analyzed risk for those with very elevated levels (>310 192); elevated, 23% (n ¼ 126). Men were more likely than kU/L, the 90th percentile). In the UCSF laboratory, the women to have borderline or elevated total IgE, as were range of coefficients of variation percent for measures of current smokers and those who quit <15 years ago (data total IgE is 2.0 to 2.8 within assays and 5.3 to 9.1 between. not shown in tables).
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