Cancer Causes & Control

, Volume 30, Issue 4, pp 323–331 | Cite as

Lifetime alcohol intake and pancreatic cancer incidence and survival: findings from the Melbourne Collaborative Cohort Study

  • Harindra JayasekaraEmail author
  • Dallas R. English
  • Allison M. Hodge
  • Robin Room
  • John L. Hopper
  • Roger L. Milne
  • Graham G. Giles
  • Robert J. MacInnis
Original Paper



Pancreatic cancer has one of the worst prognoses with 5-year survival below 10%. There is some evidence that alcohol consumption might increase the risk of pancreatic cancer. We examined associations of pre-diagnostic alcohol intake with (i) incidence of pancreatic cancer, and (ii) overall survival following pancreatic cancer.


Usual alcohol intake was estimated at recruitment in 1990–1994 for 38,472 participants in the Melbourne Collaborative Cohort Study using recalled frequency and quantity of beverage-specific intake for 10-year periods from age 20. Pancreatic cancer incidence (C25 according to International Classification of Diseases for Oncology) and vital status were ascertained through to 30 September 2015. Cox regression was performed to estimate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for associations with lifetime, age 20–29, and baseline alcohol intakes.


By the end of follow-up (average 20.2 years), 239 incident cases of pancreatic cancer were diagnosed, of which 228 had died. No evidence of an association was observed between alcohol intake and risk of pancreatic cancer. Higher lifetime alcohol intake was associated with lower overall survival following a diagnosis of pancreatic cancer (mortality HR 1.09 per 10 g/day increment, 95% CI 1.00–1.19; p value = 0.04). A similar finding was observed for age 20–29 intake (HR 1.09 per 10 g/day increment, 95% CI 1.02–1.18; p value = 0.01) but not with baseline intake.


We observed an association between lower alcohol use from an early age and improved survival following pancreatic cancer, but this finding needs to be confirmed by other studies.


Alcohol intake Incidence Pancreatic cancer Survival 



Confidence interval


Hazard ratio


Melbourne Collaborative Cohort Study



We thank the original investigators and the diligent team, who recruited the participants and who continue working on follow-up, for their contribution. We also express our gratitude to the many thousands of Melbourne residents who continue to participate in the study. MCCS cohort recruitment was funded by VicHealth and Cancer Council Victoria. The MCCS was further supported by Australian National Health and Medical Research Council Grants 209057, 251553, and 504711 and by infrastructure provided by Cancer Council Victoria. JLH is a NHMRC Senior Principal Research Fellow. RR’s position was funded by the Foundation for Alcohol Research and Education. The funding sources played no role in the study design, in the collection, analysis and interpretation of data, in the writing of the report, and in the decision to submit the article for publication.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Supplementary material

10552_2019_1146_MOESM1_ESM.docx (12 kb)
Supplementary material 1 (DOCX 12 KB)


  1. 1.
    Jemal A, Ward EM, Johnson CJ et al (2017) Annual report to the nation on the status of cancer, 1975–2014, featuring survival. J Natl Cancer Inst. Google Scholar
  2. 2.
    Buscail L (2017) Commentary: pancreatic cancer: is the worst to come? Int J Epidemiol 46(6):1774–1775CrossRefGoogle Scholar
  3. 3.
    Burris HA 3rd, Moore MJ, Andersen J et al (1997) Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J Clin Oncol 15(6):2403–2413CrossRefGoogle Scholar
  4. 4.
    Conroy T, Desseigne F, Ychou M et al (2011) FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med 364(19):1817–1825CrossRefGoogle Scholar
  5. 5.
    Von Hoff DD, Ervin T, Arena FP et al (2013) Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med 369(18):1691–1703CrossRefGoogle Scholar
  6. 6.
    Ryan DP, Hong TS, Bardeesy N (2014) Pancreatic adenocarcinoma. N Engl J Med 371(11):1039–1049CrossRefGoogle Scholar
  7. 7.
    Bouvier A-M, Uhry Z, Jooste V et al (2017) Focus on an unusual rise in pancreatic cancer incidence in France. Int J Epidemiol 46(6):1764–1772CrossRefGoogle Scholar
  8. 8.
    Are C, Chowdhury S, Ahmad H et al (2016) Predictive global trends in the incidence and mortality of pancreatic cancer based on geographic location, socio-economic status, and demographic shift. J Surg Oncol 114(6):736–742CrossRefGoogle Scholar
  9. 9.
    Baan R, Straif K, Grosse Y et al (2007) Carcinogenicity of alcoholic beverages. Lancet Oncol 8(4):292–293CrossRefGoogle Scholar
  10. 10.
    International Agency for Research on Cancer. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans (2009) Personal habits and indoor combustions, in a review of human carcinogens. IARC, LyonGoogle Scholar
  11. 11.
    World Cancer Research Fund/American Institute for Cancer Research (2012) Continuous update project report: food, nutrition, physical activity, and the prevention of pancreatic cancer. WCRF.
  12. 12.
    The Lancet (2017) Alcohol and cancer. Lancet 90(10109):2215. CrossRefGoogle Scholar
  13. 13.
    National Health and Medical Research Council (2009) Australian guidelines to reduce health risks from alcohol drinking. Commonwealth of Australia, CanberraGoogle Scholar
  14. 14.
    LoConte NK, Brewster AM, Kaur JS et al (2017) Alcohol and cancer: a statement of the American Society of Clinical Oncology. J Clin Oncol 36(1):83–93CrossRefGoogle Scholar
  15. 15.
    Russell M, Peirce RS, Vana JE et al (1998) Relations among alcohol consumption measures derived from the cognitive lifetime drinking history. Drug Alcohol Rev 17(4):377–387CrossRefGoogle Scholar
  16. 16.
    Milne RL, Fletcher AS, MacInnis RJ et al (2017) Cohort profile: The Melbourne Collaborative Cohort Study (Health 2020). Int J Epidemiol 46(6):1757–1757i. CrossRefGoogle Scholar
  17. 17.
    National Heart Foundation of Australia and Australian Institute of Health (1991) Risk factor prevalence study: survey no. 3 1989, cities analysis. National Heart Foundation of Australia and Australian Institute of Health, CanberraGoogle Scholar
  18. 18.
    Australian Institute of Health and Welfare (2003) The active Australia survey: a guide and manual for implementation, analysis and reporting. Australian Institute of Health and Welfare, CanberraGoogle Scholar
  19. 19.
    Haydon AMM, MacInnis RJ, English DR et al (2006) Effect of physical activity and body size on survival after diagnosis with colorectal cancer. Gut 55(1):62–67CrossRefGoogle Scholar
  20. 20.
    Ainsworth BE, Haskell WL, Leon AS et al (1993) Compendium of physical activities: classification of energy costs of human physical activities. Med Sci Sports Exerc 25(1):71–80CrossRefGoogle Scholar
  21. 21.
    Lohman TG, Roche AF, Martorell R (1988) Anthropometric standardization reference manual. Human Kinetics Books, ChampaignGoogle Scholar
  22. 22.
    Ireland P, Jolley D, Giles G et al (1994) Development of the Melbourne FFQ: a food frequency questionnaire for use in an Australian prospective study involving an ethnically diverse cohort. Asia Pac J Clin Nutr 3(1):19–31Google Scholar
  23. 23.
    Lewis J, Milligan G, Hunt A (1995) Nuttab95: nutrient data table for use in Australia. Australian Government Publishing Service, CanberraGoogle Scholar
  24. 24.
    Hodge AM, Simpson JA, Gibson RA et al (2007) Plasma phospholipid fatty acid composition as a biomarker of habitual dietary fat intake in an ethnically diverse cohort. Nutr Metab Cardiovasc Dis 17(6):415–426CrossRefGoogle Scholar
  25. 25.
    Hodge AM, Simpson JA, Fridman M et al (2009) Evaluation of an FFQ for assessment of antioxidant intake using plasma biomarkers in an ethnically diverse population. Public Health Nutr 12(12):2438–2447CrossRefGoogle Scholar
  26. 26.
    Jayasekara H, Macinnis RJ, Hodge AM et al (2015) Alcohol consumption for different periods in life, intake pattern over time and all-cause mortality. J Public Health 37(4):625–633Google Scholar
  27. 27.
    Korn EL, Graubard BI, Midthune D (1997) Time-to-event analysis of longitudinal follow-up of a survey: choice of the time-scale. Am J Epidemiol 145(1):72–80CrossRefGoogle Scholar
  28. 28.
    Harrell FE Jr, Lee KL, Pollock BG (1988) Regression models in clinical studies: determining relationships between predictors and response. J Natl Cancer Inst 80(15):1198–1202CrossRefGoogle Scholar
  29. 29.
    Kirkwood BR, Sterne JAC (2010) Essential medical statistics, 2nd edn. Blackwell, HobokenGoogle Scholar
  30. 30.
    Duell EJ, Lucenteforte E, Olson SH et al (2012) Pancreatitis and pancreatic cancer risk: a pooled analysis in the International pancreatic cancer case-control consortium (PanC4). Ann Oncol 23(11):2964–2970CrossRefGoogle Scholar
  31. 31.
    Witt H, Apte MV, Keim V et al. Chronic pancreatitis: challenges and advances in pathogenesis, genetics, diagnosis, and therapy. Gastroenterology 132:1557–1573Google Scholar
  32. 32.
    Dufour MC, Adamson MD (2003) The epidemiology of alcohol-induced pancreatitis. Pancreas 27(4):286–290CrossRefGoogle Scholar
  33. 33.
    Lowenfels AB, Maisonneuve P, Cavallini G et al (1993) Pancreatitis and the risk of pancreatic cancer. N Engl J Med 328(20):1433–1437CrossRefGoogle Scholar
  34. 34.
    Naudin S, Li K, Jaouen T et al (2018) Lifetime and baseline alcohol intakes and risk of pancreatic cancer in the European prospective investigation into cancer and nutrition study. Int J Cancer 143(4):801–812CrossRefGoogle Scholar
  35. 35.
    Jiao L, Silverman DT, Schairer C et al (2009) Alcohol use and risk of pancreatic cancer: the NIH-AARP diet and health study. Am J Epidemiol 169(9):1043–1051CrossRefGoogle Scholar
  36. 36.
    Heinen MM, Verhage BA, Ambergen TA et al (2009) Alcohol consumption and risk of pancreatic cancer in the Netherlands cohort study. Am J Epidemiol 169(10):1233–1242CrossRefGoogle Scholar
  37. 37.
    Tramacere I, Scotti L, Jenab M et al (2010) Alcohol drinking and pancreatic cancer risk: a meta-analysis of the dose-risk relation. Int J Cancer 126(6):1474–1486Google Scholar
  38. 38.
    Michaud DS, Vrieling A, Jiao L et al (2010) Alcohol intake and pancreatic cancer: a pooled analysis from the pancreatic cancer cohort consortium (PanScan). Cancer Causes Control 21(8):1213–1225CrossRefGoogle Scholar
  39. 39.
    Genkinger JM, Spiegelman D, Anderson KE et al (2009) Alcohol intake and pancreatic cancer risk: a pooled analysis of fourteen cohort studies. Cancer Epidemiol Biomark Prev 18(3):765–776CrossRefGoogle Scholar
  40. 40.
    Go VLW, Gukovskaya A, Pandol SJ (2005) Alcohol and pancreatic cancer. Alcohol 35(3):205–211CrossRefGoogle Scholar
  41. 41.
    Lee ATK, Xu Z, Pothula SP et al (2015) Alcohol and cigarette smoke components activate human pancreatic stellate cells: implications for the progression of chronic pancreatitis. Alcohol Clin Exp Res 39(11):2123–2133CrossRefGoogle Scholar
  42. 42.
    Duell EJ (2012) Epidemiology and potential mechanisms of tobacco smoking and heavy alcohol consumption in pancreatic cancer. Mol Carcinog 51(1):40–52CrossRefGoogle Scholar
  43. 43.
    Yu GP, Ostroff JS, Zhang ZF et al (1997) Smoking history and cancer patient survival: a hospital cancer registry study. Cancer Detect Prev 21(6):497–509Google Scholar
  44. 44.
    Coughlin SS, Calle EE, Patel AV et al (2000) Predictors of pancreatic cancer mortality among a large cohort of United States adults. Cancer Causes Control 11(10):915–923CrossRefGoogle Scholar
  45. 45.
    Nakamura K, Nagata C, Wada K et al (2011) Cigarette smoking and other lifestyle factors in relation to the risk of pancreatic cancer death: a prospective cohort study in Japan. Jpn J Clin Oncol 41(2):225–231CrossRefGoogle Scholar
  46. 46.
    Pelucchi C, Galeone C, Polesel J et al (2014) Smoking and body mass index and survival in pancreatic cancer patients. Pancreas 43(1):47–52CrossRefGoogle Scholar
  47. 47.
    Gapstur SM, Jacobs EJ, Deka A et al (2011) Association of alcohol intake with pancreatic cancer mortality in never smokers. Arch Intern Med 171(5):444–451CrossRefGoogle Scholar
  48. 48.
    Notta F, Hahn SA, Real FX (2017) A genetic roadmap of pancreatic cancer: still evolving. Gut 66(12):2170–2178CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Cancer Epidemiology and Intelligence DivisionCancer Council VictoriaMelbourneAustralia
  2. 2.Colorectal Oncogenomics Group, Department of Clinical PathologyThe University of MelbourneParkvilleAustralia
  3. 3.University of Melbourne Centre for Cancer ResearchVictorian Comprehensive Cancer CentreMelbourneAustralia
  4. 4.Centre for Alcohol Policy ResearchLa Trobe UniversityMelbourneAustralia
  5. 5.Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneAustralia
  6. 6.Centre for Health Equity, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneAustralia
  7. 7.Centre for Social Research on Alcohol and DrugsStockholm UniversityStockholmSweden

Personalised recommendations