Alcohol and Tobacco Lower the Age of Presentation in Sporadic Pancreatic Cancer in a Dose-Dependent Manner: A Multicenter Study

• Published in: The American journal of gastroenterology Vol. 107; no. 11; pp. 1730 - 1739
• Main Authors: ANDERSON, Michelle A, ZOLOTAREVSKY, Eugene, SASSON, Aaron R, GRIZZLE, William E, KETCHAM, Marsha A, LEE, Shih-Yuan, NORMOLLE, Daniel, PLONKA, Caitlyn M, MERTENS, Amy N, TRIPON, Renee C, BRAND, Randall E, COOPER, Kristine L, SHERMAN, Simon, SHATS, Oleg, WHITCOMB, David C, LYNCH, Henry T, GHIORZO, Paola, RUBINSTEIN, Wendy S, VOGEL, Kristen J
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01-11-2012; Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
• Subjects: Adenocarcinoma - epidemiology; Age of Onset; Aged; Alcohol Drinking - adverse effects; Biological and medical sciences; Body Mass Index; Chi-Square Distribution; Female; Gastroenterology; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Linear Models; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Pancreatic cancer; Pancreatic Neoplasms - epidemiology; Proportional Hazards Models; Prospective Studies; Registries; Risk Factors; Smoking - adverse effects; Tumors; Tobacco; Sporadic; Pancreas cancer; Gastroenterology; Digestive diseases; Alcohol; Malignant tumor; Dose; Age; Cancer; Pancreatic disease
• ISSN: 0002-9270; 1572-0241
• DOI: 10.1038/ajg.2012.288

The objective of this study was to examine the association between tobacco and alcohol dose and type and the age of onset of pancreatic adenocarcinoma (PancCa).
Prospective data from the Pancreatic Cancer Collaborative Registry were used to examine the association between age of onset and variables of interest including: gender, race, birth country, educational status, family history of PancCa, diabetes status, and tobacco and alcohol use. Statistical analysis included logistic and linear regression, Cox proportional hazard regression, and time-to-event analysis.
The median age to diagnosis for PancCa was 66.3 years (95% confidence intervals (CIs), 64.5-68.0). Males were more likely than females to be smokers (77% vs. 69%, P=0.0002) and heavy alcohol and beer consumers (19% vs. 6%, 34% vs. 19%, P<0.0001). In univariate analysis for effects on PancCa presentation age, the following were significant: gender, alcohol and tobacco use (amount, status and type), family history of PancCa, and body mass index. Both alcohol and tobacco had dose-dependent effects. In multivariate analysis, alcohol status and dose were independently associated with increased risk for earlier PancCa onset with greatest risk occurring in heavy drinkers (HR 1.62, 95% CI 1.04-2.54). Smoking status had the highest risk for earlier onset pancreatic cancer with a HR of 2.69 (95% CI, 1.97-3.68) for active smokers and independent effects for dose (P=0.019). The deleterious effects for alcohol and tobacco appear to resolve after 10 years of abstinence.
Alcohol and tobacco use are associated with a dose-related increased risk for earlier age of onset of PancCa. Although beer drinkers develop pancreatic cancer at an earlier age than nondrinkers, alcohol type did not have a significant effect after controlling for alcohol dose.