The pancreas is an abdominal organ that secretes enzymes and other compounds to aid digestion, as well as hormones to control blood sugar levels. Pancreatic cancer is often asymptomatic in the early stages; therefore, diagnosis usually occurs in the later stages of the disease which often leads to a poor prognosis.1 Risk factors for pancreatic cancer include smoking, obesity, diabetes, chronic pancreatitis, and a family history of the disease.1
In Australia, 4,641 cases of pancreatic cancer were diagnosed and 3,902 people died from the disease in 2024.2,3 Pancreatic cancer has a relatively low survival rate, with approximately 13% of people surviving for 5 years or more after diagnosis based on data from the period 2016–2020.1,4 It was estimated to be the third most common cause of death from cancer in Australia in 2024.5
People with pancreatic cancer often face difficult health problems such as diarrhoea, vomiting and severe pain that keeps them up at night. Side effects from treatments such as chemotherapy also make life difficult.6
3.5.10.1 Risk associated with smoking
Smoking causes pancreatic cancer.1,7,8,9
A pooled analysis of 12 international prospective cohort studies involving almost 1,500 cases found that people who currently smoke have 77% higher odds of pancreatic cancer than people who never smoked.10 An Australian study showed that, for people aged 45 and above, the risk of pancreatic cancer for people who smoke was 2.7-fold higher than for people who never smoked.11 Moreover, a large multiethnic cohort study concluded that 50 pack-years of smoking is associated with a 91% increased risk of pancreatic cancer relative to not smoking.12
3.5.10.2 How tobacco smoke causes pancreatic cancer
NNK and its break-down product NNAL, discussed in Chapter 3, Section 3.3, are the two known pancreatic carcinogens in tobacco products.13 Cigarette smoke is also known to increase the presence of DNA adducts, which can cause genetic mutations in pancreatic cells and subsequently cancer in the pancreatic tissue.14
3.5.10.3 Factors affecting risk
Intensity and duration of smoking
The risk of pancreatic cancer increases with smoking intensity (cigarettes per day), smoking duration (years smoked) and cumulative smoking dose (pack-years). This risk decreases after quitting, though it may take 10–20 years to reach the same level of risk as that of people who have never smoked.10,12,15
In Australia, male pancreatic cancer mortality has declined in line with reductions in tobacco consumption approximately 15 years previously.16 However, pancreatic cancer mortality has continued to rise in Australian women. This may be due to the later peak in female tobacco consumption (compared with male tobacco consumption) or due to other factors, such as obesity, that are affecting female pancreatic cancer mortality.16
Alcohol consumption
Heavy alcohol consumption is also associated with an increased risk of pancreatic cancer. A comprehensive review investigating the potential interactive effect of smoking and alcohol consumption on risk, concluded that larger research studies are needed determine the extent of this interaction.17
3.5.10.4 Impact of smoking on prognosis
A meta-analysis from 2019 found that people who currently smoke or formerly smoked had a greater risk of mortality from pancreatic cancer compared to people who never smoked.18
Related reading
Test your knowledge
References
1. Mizrahi JD, Surana R, Valle JW, and Shroff RT. Pancreatic cancer. Lancet, 2020; 395(10242):2008-20. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32593337
2. Australian Institute of Health and Welfare. Cancer data in Australia. Data tables: CDIA 2024: Book 1a – Cancer incidence (age-standardised rates and 5-year age groups) Canberra: AIHW. 2024. Available from: https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia/data.
3. Australian Institute of Health and Welfare. Cancer data in Australia. Data tables: CDIA 2024: Book 2a – Cancer mortality (age-standardised rates and 5-year age groups) Canberra: AIHW. 2024. Available from: https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia/data.
4. Australian Institute of Health and Welfare. Cancer data in Australia. Data tables: CDIA 2024: Book 3a – Cancer survival summary (observed, relative and conditional estimates) Canberra: AIHW. 2024. Available from: https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia/data.
5. Australian Institute of Health and Welfare. Cancer data in Australia. Canberra: AIHW. 2024. Available from: https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia.
6. Cancer Council Australia. Understanding pancreatic cancer, Cancer Council Australia, Editor 2024: Sydney, Australia. Available from: https://www.cancervic.org.au/downloads/booklets/Understanding-Pancreatic-Cancer.pdf.
7. International Agency for Research on Cancer Working Group on the Evaluation of Carcinogenic Risks to Humans. Tobacco smoke and involuntary smoking. IARC monographs on the evaluation of the carcinogenic risk of chemicals to humans. Volume 83. Lyon: International Agency for Research on Cancer. 2004. Available from: https://publications.iarc.fr/Book-And-Report-Series/Iarc-Monographs-On-The-Identification-Of-Carcinogenic-Hazards-To-Humans/Tobacco-Smoke-And-Involuntary-Smoking-2004.
8. US Department of Health and Human Services. The health consequences of smoking: a report of the Surgeon General. Atlanta, Georgia: US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. 2004. Available from: https://archive.cdc.gov/www_cdc_gov/tobacco/sgr/2004/index.htm.
9. Maisonneuve P and Lowenfels AB. Risk factors for pancreatic cancer: a summary review of meta-analytical studies. International Journal of Epidemiology, 2015; 44(1):186-98. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25502106
10. Lynch SM, Vrieling A, Lubin JH, Kraft P, Mendelsohn JB, et al. Cigarette smoking and pancreatic cancer: a pooled analysis from the pancreatic cancer cohort consortium. American Journal of Epidemiology, 2009; 170(4):403-13. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19561064
11. Weber MF, Sarich PEA, Vaneckova P, Wade S, Egger S, et al. Cancer incidence and cancer death in relation to tobacco smoking in a population-based Australian cohort study. International Journal of Cancer, 2021; 149(5):1076-88. Available from: https://www.ncbi.nlm.nih.gov/pubmed/34015143
12. Bogumil D, Stram D, Preston DL, Pandol SJ, Wu AH, et al. Excess pancreatic cancer risk due to smoking and modifying effect of quitting smoking: The Multiethnic Cohort Study. Cancer Causes and Control, 2024; 35(3):541-8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/37924460
13. US Department of Health and Human Services. How tobacco smoke causes disease: the biology and behavioral basis for smoking-attributable disease. A report of the US Surgeon General Atlanta, Georgia: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. 2010. Available from: https://www.ncbi.nlm.nih.gov/books/NBK53017/.
14. Wittel UA, Momi N, Seifert G, Wiech T, Hopt UT, et al. The pathobiological impact of cigarette smoke on pancreatic cancer development (review). International Journal of Oncology, 2012; 41(1):5-14. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22446714
15. Lugo A, Peveri G, Bosetti C, Bagnardi V, Crippa A, et al. Strong excess risk of pancreatic cancer for low frequency and duration of cigarette smoking: A comprehensive review and meta-analysis. European Journal of Cancer, 2018; 104:117-26. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30347287
16. Adair T, Hoy D, Dettrick Z, and Lopez AD. Tobacco consumption and pancreatic cancer mortality: what can we conclude from historical data in Australia? European Journal of Public Health, 2012; 22(2):243-7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21616993
17. Korc M, Jeon CY, Edderkaoui M, Pandol SJ, Petrov MS, et al. Tobacco and alcohol as risk factors for pancreatic cancer. Best Practice and Research. Clinical Gastroenterology, 2017; 31(5):529-36. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29195672
18. Ben QW, Liu J, Sun YW, Wang LF, Zou DW, et al. Cigarette smoking and mortality in patients with pancreatic cancer: A systematic review and meta-analysis. Pancreas, 2019; 48(8):985-95. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31425484