title: Alcohol and tobacco lower the age of presentation in sporadic pancreatic cancer in a dose-dependent manner: a multicenter study.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA. maaander@umich.edu
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Anderson
authors.forename: Eugene
authors.initials: E
authors.lastname: Zolotarevsky
authors.forename: Kristine L
authors.initials: KL
authors.lastname: Cooper
authors.forename: Simon
authors.initials: S
authors.lastname: Sherman
authors.forename: Oleg
authors.initials: O
authors.lastname: Shats
authors.forename: David C
authors.initials: DC
authors.lastname: Whitcomb
authors.forename: Henry T
authors.initials: HT
authors.lastname: Lynch
authors.forename: Paola
authors.initials: P
authors.lastname: Ghiorzo
authors.forename: Wendy S
authors.initials: WS
authors.lastname: Rubinstein
authors.forename: Kristen J
authors.initials: KJ
authors.lastname: Vogel
authors.forename: Aaron R
authors.initials: AR
authors.lastname: Sasson
authors.forename: William E
authors.initials: WE
authors.lastname: Grizzle
authors.forename: Marsha A
authors.initials: MA
authors.lastname: Ketcham
authors.forename: Shih-Yuan
authors.initials: SY
authors.lastname: Lee
authors.forename: Daniel
authors.initials: D
authors.lastname: Normolle
authors.forename: Caitlyn M
authors.initials: CM
authors.lastname: Plonka
authors.forename: Amy N
authors.initials: AN
authors.lastname: Mertens
authors.forename: Renee C
authors.initials: RC
authors.lastname: Tripon
authors.forename: Randall E
authors.initials: RE
authors.lastname: Brand
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology*; D017668:Age of Onset; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects*; D015992:Body Mass Index; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000453:epidemiology*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*