Smoking cessation

Avoid

7 studies · 1 recommendation

Last updated: February 27, 2026

Avoid7 studies

Smoking doubles pancreatic cancer risk; quitting returns risk toward baseline levels

Seven cohort studies encompassing over 2.7 million participants consistently link tobacco smoking to substantially elevated pancreatic cancer risk. Current smokers face a 2- to 2.4-fold increased risk compared to never smokers (HR 2.14–2.39), with a clear dose-response relationship: smoking more than 15 cigarettes daily raises risk by 77%, and exceeding 30 pack-years by 76–89%. A Nordic twin study of 127,575 participants confirmed this association even after controlling for identical genetic backgrounds (HR 1.85 among discordant monozygotic twins). Former smokers show markedly reduced risk (HR 1.10–1.31), demonstrating that cessation substantially reverses the hazard. Population-level estimates suggest eliminating tobacco smoking could reduce pancreatic cancer incidence by up to 27%. Women may face greater susceptibility to smoking-related pancreatic carcinogenesis than men.

Evidence

A healthy lifestyle index and cancer: Using a multifactor lifestyle exposure to estimate cancer incidence and survival among Norwegian women

Authors: Chen, Sairah Lai Fa

Published: August 17, 2023

Among approximately 170,000 women in the Norwegian Women and Cancer Study, a higher HLI score was associated with lower pancreatic cancer risk. The HLI incorporated five modifiable lifestyle factors: physical activity, BMI, smoking, alcohol, and diet. Smoking was identified as particularly strong in driving several of the observed associations between lifestyle and cancer incidence. Cox proportional hazard models were used to estimate these associations in this national prospective cohort.

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Cancer in twin pairs discordant for smoking : The Nordic Twin Study of Cancer

Authors: Adami, Hans-Olov, Clemmensen, Signe, Harris, Jennifer R., Hjelmborg, Jacob, Kaprio, Jaakko, Korhonen, Tellervo, Nordic Twin Study Canc NorTwinCan

Published: January 1, 2022

This Nordic twin study followed 127,575 participants for a median of 27 years. Pancreatic cancer was one of eight tobacco-related cancer sites analyzed, with 7,379 total cases across all sites. Current smokers had more than double the risk (HR 2.14, 95% CI: 1.95–2.34) compared to never smokers. Former smokers had HR 1.31 (95% CI: 1.17–1.48). Among 109 discordant monozygotic twin pairs, the smoking twin had HR 1.85 (95% CI: 1.15–2.98), confirming elevated risk after controlling for identical genetic background.

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The association between smoking and the risk of pancreatic cancer - The Norwegian women and cancer (NOWAC) study

Authors: Anwar, Muneeba

Published: January 1, 2021

In this prospective cohort of 149,243 Norwegian women followed through December 2019, ever smokers had a 66% increased risk of pancreatic cancer compared to never smokers (HR = 1.66; 95% CI = 1.34–2.06). Current smokers had a 2.39-fold increased risk (HR = 2.39; 95% CI = 1.90–3.02), while former smokers had a non-significant 10% increase (HR = 1.10; 95% CI = 0.85–1.42). A dose-response relationship was observed: smoking more than 15 cigarettes per day was associated with a 77% increased risk (HR = 1.77; 95% CI = 1.26–2.48), and smoking for more than 30 years was associated with an 89% increased risk (HR = 1.89; 95% CI = 1.44–2.48). Multivariate models adjusted for age, education, BMI, and physical activity.

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Interethnic differences in pancreatic cancer incidence and risk factors: The Multiethnic Cohort.

Authors: Haiman, Christopher A, Huang, Brian Z, Le Marchand, Loic, Monroe, Kristine R, Pandol, Stephen J, Setiawan, Veronica Wendy, Stram, Daniel O, Wilkens, Lynne R, Zhang, Zuo-Feng

Published: July 1, 2019

In this prospective cohort study of 184,559 participants followed for an average of 16.9 years, 1,532 incident pancreatic cancer cases were identified. Current smoking was strongly associated with increased pancreatic cancer risk: less than 20 pack-years showed RR 1.43 (95% CI 1.19-1.73), while 20 or more pack-years demonstrated RR 1.76 (95% CI 1.46-2.12). This dose-response relationship indicates that heavier smoking confers progressively greater risk, with long-term heavy smokers facing 76% higher pancreatic cancer risk compared to non-smokers.

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Sex, hormonal factors and pancreatic cancer

Authors: Andersson, Gustav

Published: January 1, 2019

In the Malmö Diet and Cancer Study, a prospective population-based cohort of 28,098 participants followed over time using Cox proportional hazards regression models, smoking was confirmed as one of the most significant risk factors for pancreatic cancer. The analysis further proposed a greater risk increase among women compared to men. Pancreatic cancer accounts for 3% of all incident cancer cases in developed countries yet ranks as the 7th most common cause of cancer-related death, underscoring the importance of modifiable risk factors. The sex-stratified analysis from this large Scandinavian cohort adds to existing evidence that tobacco smoking drives pancreatic carcinogenesis, with women being potentially more susceptible to these hazardous effects.

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Tobacco and alcohol as risk factors for pancreatic cancer

Authors: Edderkaoui, Mouad, Jeon, Christie Y., Korc, Murray, Pandol, Stephen J., Petrov, Maxim S.

Published: January 1, 2017

Analysis of more than 2 million unselected individuals from the general population quantified the risk of pancreatic cancer in relation to lifelong tobacco smoking status. Modifying lifestyle risk factors, most notably tobacco smoking, may reduce pancreatic cancer risk by up to 27%. Animal studies on genetically engineered mouse models of pancreatic precursor lesions further confirmed tobacco smoke's role in activating pancreatic carcinogenesis through alteration of the immune microenvironment.

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Body mass index and risk of pancreatic cancer in a Chinese population

Authors: A Berrington de Gonzalez, A Seow, A Seow, AA Arsian, Ai Zhen Jin, Andrew O. Odegaard, AO Odegaard, AR Hart, AV Patel, C Samanic, C Samanic, CA Conover, Consultation WHO Expert, D Albanes, DM Parkin, DS Michaud, E Giovannucci, EE Calle, J Luo, J Luo, J Ma, JE Manson, JH Hankin, Jian-Min Yuan, K Wada, KA Perkins, Kristin E. Anderson, L Jiao, LN Jiao Anderson, M Wang, P Deurenberg, R Durazo-Arizu, R LinY, Fu, RC Klesges, RJ Kuczmarski, RJ Stevens, RZ Stolzenberg-Solomon, RZ Stolzenberg-Solomon, RZ Stolzenberg-Solomon, S Connor Gorber, S Iodice, SC Larsson, SC Larsson, Seema Untawale, SH Jee, SO Olusi, Suminori Akiba, U Nothlings, WH Tsong, Woon-Puay Koh, WP Koh, XH Lu, Y Lin

Published: January 1, 2014

In this prospective cohort of 51,251 Chinese men and women aged 45–74 followed through December 2011, 194 developed pancreatic cancer. Among ever smokers, underweight individuals (BMI <18.5 kg/m²) had a significantly elevated pancreatic cancer risk compared to those with BMI 21.5–24.4 kg/m² (HR = 1.99, 95% CI = 1.03–3.84). The interaction between BMI and smoking status was statistically significant (p = 0.018). This association strengthened after excluding the first three years of follow-up, suggesting it was not driven by reverse causation from preclinical disease.

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