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

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 (<i>n</i> = 938) included adults exposed to organophosphate or carbamate insecticide and the control group <i>(n</i> = 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 <i>p</i> < 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.