Alcohol intake and pancreatic cancer risk: An analysis from 30 prospective studies across Asia, Australia, Europe, and North America

Sabine Naudin, International Agency for Research on Cancer, World Health Organization, Lyon, France.
Molin Wang, Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America.
Niki Dimou, International Agency for Research on Cancer, World Health Organization, Lyon, France.
Elmira Ebrahimi, International Agency for Research on Cancer, World Health Organization, Lyon, France.
Jeanine Genkinger, Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, New York, United States of America.
Hans-Olov Adami, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Demetrius Albanes, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, United States of America.
Ana Babic, Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, United States of America.
Matt Barnett, Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington, United States of America.
David Bogumil, Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, California, United States of America.
Hui Cai, Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America.
Chu Chen, Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington, United States of America.
A Heather Eliassen, Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America.
Jo L. Freudenheim, Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, United States of America.
Gretchen Gierach, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, United States of America.
Edward L. Giovannucci, Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America.
Marc J. Gunter, International Agency for Research on Cancer, World Health Organization, Lyon, France.
Niclas Håkansson, Department of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Mayo Hirabayashi, Division of Prevention, National Cancer Center Institute for Cancer Control, Tokyo, Japan.
Tao Hou, Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America.
Brian Z. Huang, Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, California, United States of America.
Wen-Yi Huang, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, United States of America.
Harindra Jayasekara, Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia.
Michael E. Jones, Division of Genetics and Epidemiology, The Institute of Cancer Research, London, United Kingdom.
Verena A. Katzke, Division of Cancer Epidemiology, Nutritional Epidemioloy, German Cancer Research Center, Heidelberg, Germany.
Woon-Puay Koh, Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
James V. Lacey, Department of Computational and Quantitative Medicine, Beckman Research Institute, City of Hope, Duarte, California, United States of America.
Ylva Trolle Lagerros, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
Susanna C. Larsson, Department of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Linda M. Liao, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, United States of America.
Kenneth Lo, Department of Food Science and Nutrition, The Hong Kong Polytechnic University, Hong Kong SAR, China.
Erikka Loftfield, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, United States of America.

Document Type

Journal Article

Publication Date

5-1-2025

Journal

PLoS medicine

Volume

22

Issue

5

DOI

10.1371/journal.pmed.1004590

Abstract

BACKGROUND: Alcohol is a known carcinogen, yet the evidence for an association with pancreatic cancer risk is considered as limited or inconclusive by international expert panels. We examined the association between alcohol intake and pancreatic cancer risk in a large consortium of prospective studies. METHODS AND FINDINGS: Population-based individual-level data was pooled from 30 cohorts across four continents, including Asia, Australia, Europe, and North America. A total of 2,494,432 participants without cancer at baseline (62% women, 84% European ancestries, 70% alcohol drinkers [alcohol intake ≥ 0.1 g/day], 47% never smokers) were recruited between 1980 and 2013 at the median age of 57 years and 10,067 incident pancreatic cancer cases were recorded. In age- and sex-stratified Cox proportional hazards models adjusted for smoking history, diabetes status, body mass index, height, education, race and ethnicity, and physical activity, pancreatic cancer hazard ratios (HR) and 95% confidence intervals (CI) were estimated for categories of alcohol intake and in continuous for a 10 g/day increase. Potential heterogeneity by sex, smoking status, geographic regions, and type of alcoholic beverage was investigated. Alcohol intake was positively associated with pancreatic cancer risk, with HR30-to-<60 g/day and HR≥60 g/day equal to 1.12 (95% CI [1.03,1.21]) and 1.32 (95% CI [1.18,1.47]), respectively, compared to intake of 0.1 to <5 g/day. A 10 g/day increment of alcohol intake was associated with a 3% increased pancreatic cancer risk overall (HR: 1.03; 95% CI [1.02,1.04]; pvalue < 0.001) and among never smokers (HR: 1.03; 95% CI [1.01,1.06]; pvalue = 0.006), with no evidence of heterogeneity by sex (pheterogeneity = 0.274) or smoking status (pheterogeneity = 0.624). Associations were consistent in Europe-Australia (HR10 g/day = 1.03, 95% CI [1.00,1.05]; pvalue = 0.042) and North America (HR10 g/day = 1.03, 95% CI [1.02,1.05]; pvalue < 0.001), while no association was observed in cohorts from Asia (HR10 g/day = 1.00, 95% CI [0.96,1.03]; pvalue = 0.800; pheterogeneity = 0.003). Positive associations with pancreatic cancer risk were found for alcohol intake from beer (HR10 g/day = 1.02, 95% CI [1.00,1.04]; pvalue = 0.015) and spirits/liquor (HR10 g/day = 1.04, 95% CI [1.03,1.06]; pvalue < 0.001), but not wine (HR10 g/day = 1.00, 95% CI [0.98,1.03]; pvalue = 0.827). The differential associations across geographic regions and types of alcoholic beverages might reflect differences in drinking habits and deserve more investigations. CONCLUSIONS: Findings from this large-scale pooled analysis support a modest positive association between alcohol intake and pancreatic cancer risk, irrespective of sex and smoking status. Associations were particularly evident for baseline alcohol intake of at least 15 g/day in women and 30 g/day in men.

Department

Exercise and Nutrition Sciences

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