# Long-Term Risk of Pancreatic Cancer After Acute Acetylcholinesterase Inhibitor Insecticide Exposure: A Nationwide Cohort Study

## TL;DR

A single high-dose exposure to a type of insecticide increases the long-term risk of pancreatic cancer, especially in women and people with diabetes.

## Contribution

This study is the first to show a long-term pancreatic cancer risk from a single acute exposure to acetylcholinesterase inhibitor insecticides.

## Key findings

- Acute high-dose exposure to AChE inhibitor insecticide was linked to a 2.57 times higher risk of pancreatic cancer.
- Women had a 5.85 times higher risk, and people with diabetes had a 2.75 times higher risk after exposure.
- The risk was observed over a long follow-up period, suggesting a lasting effect of the exposure.

## Abstract

Although pesticide exposure has long been known to harm human health, it has not been clear whether a single episode of severe exposure to acetylcholinesterase inhibitor insecticide could have lasting effects. By analyzing nationwide Korean health records, this large study found that people who experienced one acute high-dose exposure to acetylcholinesterase inhibitor insecticide had a significantly higher chance of later developing pancreatic cancer. The risk was especially high among women and those with diabetes. These results suggest that such exposure may act as a hidden long-term pancreatic cancer risk. The findings highlight the importance of monitoring exposed individuals and guiding public health authorities to strengthen pesticide safety regulations. They further encourage physicians to consider implementing pancreatic cancer surveillance in high-risk patients and inspire future researchers to explore how acute toxic events may trigger pancreatic cancer.

This nationwide cohort study investigated whether a single episode of acute exposure to high-dose acetylcholinesterase (AChE) inhibitor insecticide is associated with an increased risk of pancreatic cancer. Data from the Korean National Health Insurance Service were analyzed. The case group (n = 938) included adults exposed to organophosphate or carbamate insecticide and the control group (n = 3752) was matched by age, sex, and socioeconomic status. Cox proportional hazards regression was used to calculate hazard ratios (HRs) and 95% confidence intervals. Kaplan–Meier curves with log-rank tests evaluated differences in pancreatic cancer incidence. Over 33,219.8 person-years of follow-up, pancreatic cancer developed in 9 patients in the case group and 19 patients in the control group. The cumulative incidence of pancreatic cancer was significantly higher in the case group (log-rank p < 0.01). Acute high-dose exposure to AChE inhibitor insecticide was associated with an increased risk of pancreatic cancer (adjusted HR: 2.57). The risk was particularly elevated among women (HR: 5.85) and individuals with diabetes (HR: 2.75). Acute high-dose exposure to AChE inhibitor insecticide may increase the risk of pancreatic cancer. Women and those with diabetes may represent high-risk subgroups. These findings highlight the need for targeted cancer surveillance and further confirmatory studies.