Cancer Causes & Control

, Volume 20, Issue 6, pp 825–834 | Cite as

Lifestyle, dietary, and medical history factors associated with pancreatic cancer risk in Ontario, Canada

  • Laura N. AndersonEmail author
  • Michelle Cotterchio
  • Steven Gallinger
Original Paper



Pancreatic adenocarcinoma has one of the worst survival rates of all the cancers. Established risk factors for this malignancy are smoking, body mass index (BMI) and family history of pancreatic cancer. Findings are inconsistent regarding pancreatitis, diabetes, allergies, intake of fruit, vegetables, red meat, alcohol, caffeine, vitamin C, calcium, and folate supplements. Possible pancreatic cancer risk factors were evaluated within the population-based Ontario Pancreas Cancer Study.


Pathologically confirmed pancreatic cancer cases (n = 422) were identified from the Ontario Cancer Registry between 2003 and 2007. Controls (n = 312) were recruited through random digit dialing. Data were collected using self-administered questionnaires. Multivariate logistic regression was used to obtain odds ratios.


Smoking, BMI, family history of pancreatic cancer, and caffeine were significantly associated with increased pancreatic cancer risk, while fruit intake and allergies significantly decreased risk. No other significant associations were observed in the multivariate model. Effect modification by smoking status was suggested for caffeine, family history of pancreatic cancer, BMI, and fruit.


This study further clarifies the association between several lifestyle, dietary and medical history factors, and pancreatic cancer risk, many of which are potentially modifiable. Possible effect modification by smoking status should be further explored in future etiologic studies.


Pancreatic neoplasms Risk factors Diet Smoking Case–control studies 



Age-adjusted odds ratio


Body mass index


Confidence interval


Multivariate-adjusted odds ratio


Ontario Cancer Registry


Ontario Familial Colon Cancer Registry


Ontario Pancreas Cancer Study


Odds ratio



The authors would like to thank Ayelet Borgida, Research Coordinator for the Ontario Pancreas Cancer Study, Mount Sinai Hospital, Toronto, Ontario, Canada. This study was supported by grants from the National Institutes of Health (R01 CA97075, as part of the PACGENE consortium), the Lustgarten Foundation for Pancreatic Cancer Research, and the Ontario Cancer Research Network. The authors’ study was independent of the funders. We acknowledge the Pancreatic Cancer Canada foundation ( for their continued support of research into the early detection of pancreatic cancer, and the Pancreas Cancer Screening Study at Mount Sinai Hospital, and at Princess Margaret Hospital.


  1. 1.
    Canadian Cancer Society/National Cancer Institute of Canada (2008) Canadian Cancer Statistics 2008Google Scholar
  2. 2.
    Hart AR, Kennedy H, Harvey I (2008) Pancreatic cancer: a review of the evidence on causation. Clin Gastroenterol Hepatol 6:275–282. doi: 10.1016/j.cgh.2007.12.041 PubMedCrossRefGoogle Scholar
  3. 3.
    Colditz GA, Atwood KA, Emmons K et al (2000) Harvard report on cancer prevention volume 4: Harvard cancer risk index. Risk Index Working Group, Harvard Center for Cancer Prevention. Cancer Causes Control 11:477–488. doi: 10.1023/A:1008984432272 PubMedCrossRefGoogle Scholar
  4. 4.
    Larsson SC, Orsini N, Wolk A (2007) Body mass index and pancreatic cancer risk: a meta-analysis of prospective studies. Int J Cancer 120:1993–1998. doi: 10.1002/ijc.22535 PubMedCrossRefGoogle Scholar
  5. 5.
    Giovannucci E, Michaud D (2007) The role of obesity and related metabolic disturbances in cancers of the colon, prostate, and pancreas. Gastroenterology 132:2208–2225. doi: 10.1053/j.gastro.2007.03.050 PubMedCrossRefGoogle Scholar
  6. 6.
    World Cancer Research Fund/American Institute for Cancer Research (2007) Food, nutrition, physical activity, and the prevention of cancer: a global perspective. American Institute for Cancer Research, WashingtonGoogle Scholar
  7. 7.
    Ghadirian P, Lynch HT, Krewski D (2003) Epidemiology of pancreatic cancer: an overview. Cancer Detect Prev 27:87–93. doi: 10.1016/S0361-090X(03)00002-3 PubMedCrossRefGoogle Scholar
  8. 8.
    Everhart J, Wright D (1995) Diabetes mellitus as a risk factor for pancreatic cancer: a meta-analysis. JAMA 273:1605–1609. doi: 10.1001/jama.273.20.1605 PubMedCrossRefGoogle Scholar
  9. 9.
    Silverman DT, Schiffman M, Everhart J et al (1999) Diabetes mellitus, other medical conditions and familial history of cancer as risk factors for pancreatic cancer. Br J Cancer 80:1830–1837. doi: 10.1038/sj.bjc.6690607 PubMedCrossRefGoogle Scholar
  10. 10.
    Lowenfels AB, Maisonneuve P (2006) Epidemiology and risk factors for pancreatic cancer. Best Pract Res Clin Gastroenterol 20:197–209. doi: 10.1016/j.bpg.2005.10.001 PubMedCrossRefGoogle Scholar
  11. 11.
    Eppel A, Cotterchio M, Gallinger S (2007) Allergies are associated with reduced pancreas cancer risk: a population-based case–control study in Ontario, Canada. Int J Cancer 121:2241–2245. doi: 10.1002/ijc.22884 PubMedCrossRefGoogle Scholar
  12. 12.
    Merrill RM, Isakson RT, Beck RE (2007) The association between allergies and cancer: what is currently known? Ann Allergy Asthma Immunol 99:102–116PubMedCrossRefGoogle Scholar
  13. 13.
    Gandini S, Lowenfels AB, Jaffee EM, Armstrong TD, Maisonneuve P (2005) Allergies and the risk of pancreatic cancer: a meta-analysis with review of epidemiology and biological mechanisms. Cancer Epidemiol Biomark Prev 14:1908–1916. doi: 10.1158/1055-9965.EPI-05-0119 CrossRefGoogle Scholar
  14. 14.
    Petersen GM, de Andrade M, Goggins M et al (2006) Pancreatic cancer genetic epidemiology consortium. Cancer Epidemiol Biomark Prev 15:704–710. doi: 10.1158/1055-9965.EPI-05-0734 CrossRefGoogle Scholar
  15. 15.
    Cotterchio M, McKeown-Eyssen G, Sutherland H et al (2000) Ontario familial colon cancer registry: methods and first-year response rates. Chronic Dis Can 21:81–86PubMedGoogle Scholar
  16. 16.
    SAS Institute Inc (2005) SAS 9.1. Windows versionGoogle Scholar
  17. 17.
    Fuchs CS, Colditz GA, Stampfer MJ et al (1996) A prospective study of cigarette smoking and the risk of pancreatic cancer. Arch Intern Med 156:2255–2260. doi: 10.1001/archinte.156.19.2255 PubMedCrossRefGoogle Scholar
  18. 18.
    Howe GR, Jain M, Burch JD, Miller AB (1991) Cigarette smoking and cancer of the pancreas: evidence from a population-based case–control study in Toronto, Canada. Int J Cancer 47:323–328. doi: 10.1002/ijc.2910470302 PubMedCrossRefGoogle Scholar
  19. 19.
    Hanley AJ, Johnson KC, Villeneuve PJ, Mao Y, Canadian Cancer Registries Epidemiology Research Group (2001) Physical activity, anthropometric factors and risk of pancreatic cancer: results from the Canadian enhanced cancer surveillance system. Int J Cancer 94:140–147. doi: 10.1002/ijc.1446 PubMedCrossRefGoogle Scholar
  20. 20.
    Permuth-Wey J, Egan KM (2008) Family history is a significant risk factor for pancreatic cancer: results from a systematic review and meta-analysis. Fam Cancer Sep 2. Epub ahead of printGoogle Scholar
  21. 21.
    Huxley R, Ansary-Moghaddam A, Berrington de Gonzalez A, Barzi F, Woodward M (2005) Type-II diabetes and pancreatic cancer: a meta-analysis of 36 studies. Br J Cancer 92:2076–2083. doi: 10.1038/sj.bjc.6602619 PubMedCrossRefGoogle Scholar
  22. 22.
    Lin Y, Kikuchi S, Tamakoshi A et al (2006) Dietary habits and pancreatic cancer risk in a cohort of middle-aged and elderly Japanese. Nutr Cancer 56:40–49. doi: 10.1207/s15327914nc5601_6 PubMedCrossRefGoogle Scholar
  23. 23.
    Larsson SC, Hakansson N, Naslund I, Bergkvist L, Wolk A (2006) Fruit and vegetable consumption in relation to pancreatic cancer risk: a prospective study. Cancer Epidemiol Biomark Prev 15:301–305. doi: 10.1158/1055-9965.EPI-05-0696 CrossRefGoogle Scholar
  24. 24.
    Chan JM, Wang F, Holly EA (2005) Vegetable and fruit intake and pancreatic cancer in a population-based case–control study in the San Francisco bay area. Cancer Epidemiol Biomark Prev 14:2093–2097. doi: 10.1158/1055-9965.EPI-05-0226 CrossRefGoogle Scholar
  25. 25.
    Howe GR, Burch JD (1996) Nutrition and pancreatic cancer. Cancer Causes Control 7:69–82. doi: 10.1007/BF00115639 PubMedCrossRefGoogle Scholar
  26. 26.
    Larsson SC, Giovannucci E, Wolk A (2006) Folate intake, MTHFR polymorphisms, and risk of esophageal, gastric, and pancreatic cancer: a meta-analysis. Gastroenterology 131:1271–1283. doi: 10.1053/j.gastro.2006.08.010 PubMedCrossRefGoogle Scholar
  27. 27.
    La Vecchia C, Tavani A (2007) Coffee and cancer risk: an update. Eur J Cancer Prev 16:385–389. doi: 10.1097/01.cej.0000243853.12728.76 PubMedCrossRefGoogle Scholar
  28. 28.
    Harnack LJ, Anderson KE, Zheng W, Folsom AR, Sellers TA, Kushi LH (1997) Smoking, alcohol, coffee, and tea intake and incidence of cancer of the exocrine pancreas: the Iowa Women’s Health Study. Cancer Epidemiol Biomark Prev 6:1081–1086Google Scholar
  29. 29.
    Ghadirian P, Simard A, Baillargeon J (1991) Tobacco, alcohol, and coffee and cancer of the pancreas: a population-based, case–control study in Quebec, Canada. Cancer 67:2664–2670. doi:10.1002/1097-0142(19910515)67:10<2664::AID-CNCR2820671043>3.0.CO;2-KPubMedCrossRefGoogle Scholar
  30. 30.
    Villeneuve PJ, Johnson KC, Hanley AJ, Mao Y (2000) Alcohol, tobacco and coffee consumption and the risk of pancreatic cancer: results from the Canadian Enhanced Surveillance System case–control project. Canadian Cancer Registries Epidemiology Research Group. Eur J Cancer Prev 9:49–58. doi: 10.1097/00008469-200002000-00007 PubMedCrossRefGoogle Scholar
  31. 31.
    Michaud DS, Giovannucci E, Willett WC, Colditz GA, Fuchs CS (2001) Coffee and alcohol consumption and the risk of pancreatic cancer in two prospective United States cohorts. Cancer Epidemiol Biomark Prev 10:429–437Google Scholar
  32. 32.
    Brown J, Kreiger N, Darlington GA, Sloan M (2001) Misclassification of exposure: coffee as a surrogate for caffeine intake. Am J Epidemiol 153:815–820. doi: 10.1093/aje/153.8.815 PubMedCrossRefGoogle Scholar
  33. 33.
    Larsson SC, Bergkvist L, Wolk A (2006) Consumption of sugar and sugar-sweetened foods and the risk of pancreatic cancer in a prospective study. Am J Clin Nutr 84:1171–1176PubMedGoogle Scholar
  34. 34.
    Schernhammer ES, Hu FB, Giovannucci E et al (2005) Sugar-sweetened soft drink consumption and risk of pancreatic cancer in two prospective cohorts. Cancer Epidemiol Biomark Prev 14:2098–2105. doi: 10.1158/1055-9965.EPI-05-0059 CrossRefGoogle Scholar
  35. 35.
    Zheng W, McLaughlin JK, Gridley G et al (1993) A cohort study of smoking, alcohol consumption, and dietary factors for pancreatic cancer (United States). Cancer Causes Control 4:477–482. doi: 10.1007/BF00050867 PubMedCrossRefGoogle Scholar
  36. 36.
    Silverman DT, Brown LM, Hoover RN et al (1995) Alcohol and pancreatic cancer in blacks and whites in the United States. Cancer Res 55:4899–4905PubMedGoogle Scholar
  37. 37.
    Partanen TJ, Vainio HU, Ojajarvi IA, Kauppinen TP (1997) Pancreas cancer, tobacco smoking and consumption of alcoholic beverages: a case–control study. Cancer Lett 116:27–32. doi: 10.1016/S0304-3835(97)04744-7 PubMedCrossRefGoogle Scholar
  38. 38.
    Farrow DC, Davis S (1990) Risk of pancreatic cancer in relation to medical history and the use of tobacco, alcohol and coffee. Int J Cancer 45:816–820. doi: 10.1002/ijc.2910450504 PubMedCrossRefGoogle Scholar
  39. 39.
    Bouchardy C, Clavel F, La Vecchia C, Raymond L, Boyle P (1990) Alcohol, beer and cancer of the pancreas. Int J Cancer 45:842–846. doi: 10.1002/ijc.2910450509 PubMedCrossRefGoogle Scholar
  40. 40.
    Tavani A, Pregnolato A, Negri E, La Vecchia C (1997) Alcohol consumption and risk of pancreatic cancer. Nutr Cancer 27:157–161PubMedCrossRefGoogle Scholar
  41. 41.
    Hassan MM, Bondy ML, Wolff RA et al (2007) Risk factors for pancreatic cancer: case–control study. Am J Gastroenterol 102:2696–2707. doi: 10.1111/j.1572-0241.2007.01510.x PubMedCrossRefGoogle Scholar
  42. 42.
    Nkondjock A, Krewski D, Johnson KC, Ghadirian P, Canadian Cancer Registries Epidemiology Research Group (2005) Dietary patterns and risk of pancreatic cancer. Int J Cancer 114:817–823. doi: 10.1002/ijc.20800 PubMedCrossRefGoogle Scholar
  43. 43.
    Nkondjock A, Krewski D, Johnson KC, Ghadirian P, Canadian Cancer Registries Epidemiology Research Group (2005) Specific fatty acid intake and the risk of pancreatic cancer in Canada. Br J Cancer 92:971–977. doi: 10.1038/sj.bjc.6602380 PubMedCrossRefGoogle Scholar
  44. 44.
    Nkondjock A, Ghadirian P, Johnson KC, Krewski D, Canadian Cancer Registries Epidemiology Research Group (2005) Dietary intake of lycopene is associated with reduced pancreatic cancer risk. J Nutr 135:592–597PubMedGoogle Scholar
  45. 45.
    Ghadirian P, Baillargeon J, Simard A, Perret C (1995) Food habits and pancreatic cancer: a case–control study of the Francophone community in Montreal, Canada. Cancer Epidemiol Biomark Prev 4:895–899Google Scholar
  46. 46.
    Ghadirian P, Simard A, Baillargeon J, Maisonneuve P, Boyle P (1991) Nutritional factors and pancreatic cancer in the francophone community in Montreal, Canada. Int J Cancer 47:1–6. doi: 10.1002/ijc.2910470102 PubMedCrossRefGoogle Scholar
  47. 47.
    Rothman KJ, Greenland S (1998) Modern epidemiology. Lippincott-Raven, Philadelphia, PA, p 127Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2009

Authors and Affiliations

  • Laura N. Anderson
    • 1
    • 2
    Email author
  • Michelle Cotterchio
    • 1
    • 2
  • Steven Gallinger
    • 3
  1. 1.Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada
  2. 2.Population Studies and SurveillanceCancer Care OntarioTorontoCanada
  3. 3.Samuel Lunenfeld Research InstituteMount Sinai HospitalTorontoCanada

Personalised recommendations