VoL 6, 1081-1086, December 1997 -CancerEpidemiology,_Blomarkers & Prevention 1081 3 The abbreviations used are: IWHS, Iowa Women’s Health Study; NNK, 4- (methylnitrosamino)-l-(3-pyridyl)-l-butanone. Smoking, Alcohol, Coffee, and Tea Intake and Incidence of Cancer of the Exocrine Pancreas: The Iowa Women’s Health Study1 Lisa J. Harnack,2 Kristin E. Anderson, Wei Zheng, Aaron R. Folsom, Thomas A. Sellers, and Lawrence H. Kushi Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, Minnesota 55454-1015 Abstract To assess the relationship of smoking and coffee, tea, and alcohol intake to the risk of cancer of the exocrine pancreas, analyses were performed using data from a prospective cohort study of 33,976 postmenopausal Iowa women who responded to a mailed questionnaire in 1986 and were followed through 1994 for cancer incidence and total mortality. At baseline, information on cigarette smoking, consumption of tea, coffee, and alcoholic beverages, and other dietary and lifestyle factors was obtained. Age-adjusted relative risks of pancreatic cancer (n 66 cases) showed a dose-response association with smoking. Those with fewer than 20 pack-years and those with 20 or more pack-years of smoking exposure were 1.14 (95% confidence interval, 0.53-2.45) and 1.92 (95% confidence interval, 1.12-2.30) times more likely, respectively, to develop pancreatic cancer than were nonsmokers. Current smokers were twice as likely as were nonsmokers to develop pancreatic cancer. Relative risks of pancreatic cancer increased with the amount of alcohol consumed (1 trend 0.11) after adjustment for age, smoking status, and pack-years of smoking. Relative risks of pancreatic cancer according to alcoholic beverage intake were as strong among never-smokers as they were in the total cohort. After the data were adjusted for age, smoking status, and pack-years of smoking, there was a statistically significant 2-fold (95% confidence interval, 1.08-4J0) elevated risk of pancreatic cancer for those who drank > 17.5 cups of coffee per week, compared to those who consumed <7 cups/week; among never- smokers, the relative risks across coffee intake categories were still positive but were attenuated somewhat (td = 0.17). Tea intake was not related to cancer incidence. In summary, these findings provide evidence of an association of both alcoholic beverage and coffee consumption with pancreatic cancer incidence that is independent of age and cigarette smoking. Received 2/26/97; revised 8/25/97; accepted 8/27/97. The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked advertisement in accordance with 18 U.S.C. Section 1734 solely to indicate this fact. 1 This work was supported by National Cancer institute Grant CA39742 and Training Grant T32CA09607 (to L. 3. H.). 2 To whom requests for reprints should be addressed, at Division of Epidemiol- ogy, School of Public Health, University of Minnesota, 1300 South Second Street, Suite 300, Minneapolis, MN 55454-1015. Introduction Cancer of the pancreas is the 10th most common incident cancer among women in the United States, with approximately 14,200 new cases expected in 1997 (1). Prognosis with the disease is poor, with a 1-year survival rate of <20%, making it the fourth leading cause of cancer death in women (1). Except for an established association with cigarette smok- ing, the etiology of pancreatic cancer is poorly understood (2). A number of studies have been conducted to determine whether coffee, tea, and/or alcohol consumption increase the risk of pancreatic cancer, but results are inconsistent. Many investiga- tors have found little evidence of an association between alco- hol intake and risk of pancreatic cancer (3-21), whereas others have found a positive (22-26) or an inverse association (27, 28). Coffee intake was found to be unrelated to the risk of pancreatic cancer in most previous studies (4-7, 10, 1 1, 13-15, 17, 20, 22-27, 29-34), although positive (8, 12, 16, 20) and inverse (9, 28) associations have also been reported. Studies of tea consumption and risk of pancreatic cancer have found no association (9, 14-16, 20, 24, 31) or an inverse association (5, 7). Few etiobogical studies of pancreatic cancer have used a prospective study design (3, 5, 14, 22, 26, 30, 32, 35). Most prior epidemiobogical investigations were retrospective studies with a high proportion of surrogate respondents, which may affect the reporting of past exposures, including alcohol, tea, and coffee consumption (36). In this prospective study, we tested the hypothesis that smoking and coffee, tea, and alcohol intake increase the risk of cancer of the exocrine pancreas. Here, we report the results from a cohort of 33,976 white American women with 9 years of follow-up. Materials and Methods The methods used in the IWHS3 have been published elsewhere (37, 38). Briefly, in January 1986, a questionnaire was sent to 98,826 randomly selected women, ages 55-69 years, whose names were included on the 1985 Iowa state driver’s license list. A total of 41,837 women (42.3%) completed the question- naire and were followed up for mortality and cancer incidence. A comparison of respondents and nonrespondents disclosed that respondents were, on average, 2 months younger and slightly more likely to live in rural, less affluent areas than were nonrespondents (39). The average age of respondents was 61.7 years; 99% of respondents were white. Vitality status for cohort members was determined through computer linkage of participant identifiers with Iowa death certificates, through mailed follow-up questionnaires in 1987, 1989, and 1992, and via the National Death Index for on December 29, 2021. © 1997 American Association for Cancer Research. cebp.aacrjournals.org Downloaded from