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Alison M. Kriegel,¹ Amr S. Soliman,² Qing Zhang,³ Nabih El-Ghawalby,⁴ Farouk Ezzat,⁴ Ahmed Soultan,⁴ Mohamed Abdel-Wahab,⁴ Omar Fathy,⁴ Gamal Ebidi,⁴ Nadia Bassiouni,⁴ Stanley R. Hamilton,⁵ James L. Abbruzzese,⁶ Michelle R. Lacey,⁷ and Diane A. Blake¹

¹Department of Biochemistry, Tulane University Health Sciences Center, New Orleans, Louisiana, USA; ²Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA; ³Department of Epidemiology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA; ⁴Gastrointestinal Surgery Center, Mansoura University, Mansoura, Egypt; ⁵Division of Pathology and Laboratory Medicine, and ⁶Department of Gastrointestinal Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA; ⁷Department of Mathematics, Tulane University, New Orleans, Louisiana, USA

Abstract
The northeast Nile Delta region exhibits a high incidence of early-onset pancreatic cancer. It is well documented that this region has one of the highest levels of pollution in Egypt. Epidemiologic studies have suggested that cadmium, a prevalent pollutant in the northeast Nile Delta region, plays a role in the development of pancreatic cancer.
Objective: We aimed to assess serum cadmium levels as markers of exposure in pancreatic cancer patients and noncancer comparison subjects from the same region in Egypt.
Design and Participants: We assessed serum cadmium levels of 31 newly diagnosed pancreatic cancer patients and 52 hospital comparison subjects from Mansoura, Egypt.
Evaluation/Measurements: Serum cadmium levels were measured using a novel immunoassay procedure.
Results: We found a significant difference between the mean serum cadmium levels in patients versus comparison subjects (mean ± SD, 11.1 ± 7.7 ng/mL vs. 7.1 ± 5.0 ng/mL, respectively ; p = 0.012) but not in age, sex, residence, occupation, or smoking status. The odds ratio (OR) for pancreatic cancer risk was significant for serum cadmium level [OR = 1.12 ; 95% confidence interval (CI) , 1.04-1.23 ; p = 0.0089] and farming (OR = 3.25 ; 95% CI, 1.03-11.64 ; p = 0.0475) but not for age, sex, residence, or smoking status.
Conclusions: The results from this pilot study suggest that pancreatic cancer in the East Nile Delta region is significantly associated with high levels of serum cadmium and farming.
Relevance to Clinical Practice/Public Health: Future studies should further investigate the etiologic relationship between cadmium exposure and pancreatic carcinogenesis in cadmium-exposed populations.
Key words: cadmium, East Nile Delta region, environmental exposure, immunoassays, occupational exposure, pancreatic cancer, pollution. Environ Health Perspect 113:113-119 (2005) . doi:10.1289/ehp.8035 available via http://dx.doi.org/ [Online 25 August 2005]

Address correspondence to A.S. Soliman, Department of Epidemiology, School of Public Health, University of Michigan, 109 Observatory Rd., Rm. 2550, Ann Arbor, MI 48109 USA. Telephone: (734) 764-5469. Fax: (734) 764-3192. E-mail: asoliman@umich.edu

We thank D. Garabrant (University of Michigan School of Public Health) for his comments during the data analysis.

This work was supported by Eli Lilly Research ; the Topfer Research fund from the M.D. Anderson Cancer Center ; National Cancer Institute grants CA K07 090241 and R03 CA099513-01 ; and University of Michigan Cancer Center Support grant 5 P30 CA46592 to A.S.S. Stipend support for A.M.K. was provided by the Office of Science (Biological and Environmental Research) , U.S. Department of Energy (grant DE-FG02-98ER62704 to D.A.B.) .

The authors declare they have no competing financial interests.

Received 21 February 2005 ; accepted 25 August 2005.