{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T02:50:14Z","timestamp":1782355814260,"version":"3.54.5"},"reference-count":54,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T00:00:00Z","timestamp":1758067200000},"content-version":"unspecified","delay-in-days":47,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Science and Technology Council, Taiwan","award":["110\u20132314\u2013B\u2013039\u2013058"],"award-info":[{"award-number":["110\u20132314\u2013B\u2013039\u2013058"]}]},{"name":"National Science and Technology Council, Taiwan","award":["111\u20132314\u2013B\u2013039\u2013020-MY2"],"award-info":[{"award-number":["111\u20132314\u2013B\u2013039\u2013020-MY2"]}]},{"name":"National Science and Technology Council, Taiwan","award":["114\u20132314\u2013B\u2013039\u2013061\u2013MY3"],"award-info":[{"award-number":["114\u20132314\u2013B\u2013039\u2013061\u2013MY3"]}]},{"DOI":"10.13039\/501100012544","name":"China Medical University, Taiwan","doi-asserted-by":"publisher","award":["CMU113\u2013S\u201313"],"award-info":[{"award-number":["CMU113\u2013S\u201313"]}],"id":[{"id":"10.13039\/501100012544","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Occup Environ Med"],"accepted":{"date-parts":[[2025,8,22]]},"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:p>Cadmium (Cd), a group 1 carcinogen, is linked to the development of pancreatic cancer. Not well-defined is the dose-response relationship between Cd and cancer development.<\/jats:p>\n               <jats:p>This study investigated the relationship between Cd exposure and the risk of pancreatic cancer through a meta-analysis focusing on pooled relative risk (RR), biomarker comparisons and dose-response relationships.<\/jats:p>\n               <jats:p>This meta-analysis adhered to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and applied the PECO (population, exposure, comparator and outcomes) framework. Systematic searches of key databases, including PubMed, Cochrane Library, Web of Science, EMBASE, ScienceDirect and ProQuest, were carried out without language restrictions. Studies that met the predefined PECO criteria were chosen, extracting data on effect estimates such as HRs, ORs, RRs and Cd biomarker concentrations. Analyses involved pooled RRs, standardised mean differences for biomarker comparisons and dose-response relationships, using random-effects meta-analysis and meta-regression. Statistical procedures were performed on R V.4.3.0.<\/jats:p>\n               <jats:p>Cd exposure was significantly associated with an increased risk of pancreatic cancer, with a pooled RR of 1.42 (95% CI=1.16 to 1.73). Subgroup analyses confirmed this association in both occupationally and non-occupationally exposed individuals. Dose-response analyses further revealed that higher Cd biomarker levels correlated with greater pancreatic cancer risk (lnRR coefficient=0.610, p=0.035).<\/jats:p>\n               <jats:p>Cd exposure is associated with an increased risk of pancreatic cancer, with a dose-response relationship and elevated biomarker levels in cases. Cd exposure is a modifiable risk factor for pancreatic cancer, meriting further investigation.<\/jats:p>","DOI":"10.1136\/oemed-2025-110163","type":"journal-article","created":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T17:20:25Z","timestamp":1758129625000},"page":"407-414","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Dose-response relationship of cadmium and pancreatic cancer risk: a meta-analysis"],"prefix":"10.1136","volume":"82","author":[{"given":"Fu-Jen","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei City, Taiwan"},{"name":"Graduate Institute of Public Health, College of Public Health, China Medical University, Taichung City, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hathaichon","family":"Inchai","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Faculty of Public Health, Mahidol University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaw-Town","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, E-Da Hospital, Kaohsiung City, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Koh","sequence":"additional","affiliation":[{"name":"Saw Swee Hock School of Public Health, National University of Singapore, Singapore"},{"name":"Department of Occupational Safety and Health, College of Public Health, China Medical University, Taichung City, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2687-203X","authenticated-orcid":false,"given":"Ro-Ting","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Occupational Safety and Health, College of Public Health, China Medical University, Taichung City, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,9,17]]},"reference":[{"key":"2025101701300849000_82.8.407.1","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1016\/S2468-1253(19)30347-4","article-title":"The global, regional, and national burden of pancreatic cancer and its attributable risk factors in 195 countries and territories, 1990\u20132017: a systematic analysis for the Global Burden of Disease Study 2017","volume":"4","author":"Pourshams","year":"2019","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"2025101701300849000_82.8.407.2","doi-asserted-by":"publisher","DOI":"10.1002\/mc.20855"},{"key":"2025101701300849000_82.8.407.3","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph17113782","article-title":"The Effects of Cadmium Toxicity","volume":"17","author":"Genchi","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"2025101701300849000_82.8.407.4","doi-asserted-by":"crossref","DOI":"10.3390\/molecules28186620","article-title":"Cadmium Toxicity and Health Effects-A Brief Summary","volume":"28","author":"Charkiewicz","year":"2023","journal-title":"Molecules"},{"key":"2025101701300849000_82.8.407.5","doi-asserted-by":"crossref","DOI":"10.1155\/2017\/1981837","article-title":"Cadmium Exposure as a Putative Risk Factor for the Development of Pancreatic Cancer: Three Different Lines of Evidence","volume":"2017","author":"Buha","year":"2017","journal-title":"Biomed Res Int"},{"key":"2025101701300849000_82.8.407.6","unstructured":"Occupational safety and health administration (OSHA) . Cadmium - 1910.1027 washington, D.C., U.S.: U.S. department of labor. 2025 Available: https:\/\/www.osha.gov\/laws-regs\/regulations\/standardnumber\/1910\/1910.1027"},{"key":"2025101701300849000_82.8.407.7","doi-asserted-by":"crossref","first-page":"114630","DOI":"10.1016\/j.envpol.2020.114630","article-title":"Levels of a mixture of heavy metals in blood and urine and all-cause, cardiovascular disease and cancer mortality: A population-based cohort study","volume":"263","author":"Duan","year":"2020","journal-title":"Environ Pollut"},{"key":"2025101701300849000_82.8.407.8","doi-asserted-by":"crossref","DOI":"10.3390\/ijms24098413","article-title":"Current Levels of Environmental Exposure to Cadmium in Industrialized Countries as a Risk Factor for Kidney Damage in the General Population: A Comprehensive Review of Available Data","volume":"24","author":"Smerecza\u0144ski","year":"2023","journal-title":"Int J Mol Sci"},{"key":"2025101701300849000_82.8.407.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.envint.2019.04.048"},{"key":"2025101701300849000_82.8.407.10","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1289\/ehp.8035","article-title":"Serum cadmium levels in pancreatic cancer patients from the East Nile Delta region of Egypt","volume":"114","author":"Kriegel","year":"2006","journal-title":"Environ Health Perspect"},{"key":"2025101701300849000_82.8.407.11","doi-asserted-by":"publisher","DOI":"10.1136\/oem.57.5.316"},{"key":"2025101701300849000_82.8.407.12","first-page":"139","article-title":"Is cadmium a cause of human pancreatic cancer?","volume":"9","author":"Schwartz","year":"2000","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"key":"2025101701300849000_82.8.407.13","doi-asserted-by":"crossref","first-page":"17465","DOI":"10.1007\/s11356-015-5464-9","article-title":"Cadmium exposure and risk of pancreatic cancer: a meta-analysis of prospective cohort studies and case-control studies among individuals without occupational exposure history","volume":"22","author":"Chen","year":"2015","journal-title":"Environ Sci Pollut Res Int"},{"key":"2025101701300849000_82.8.407.14","first-page":"260","article-title":"Investigating the Relationship Between Exposure to Cadmium and Lung Cancer Risk: A Systematic Review and Meta-analysis","volume":"41","author":"Farahmandian","year":"2023","journal-title":"JHSW"},{"key":"2025101701300849000_82.8.407.15","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"2025101701300849000_82.8.407.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.envint.2018.07.015"},{"key":"2025101701300849000_82.8.407.17","unstructured":"Office of Health Assessment and Translation (OHAT) . 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