Long-term exposure to outdoor air pollutants and risk of pancreatic cancer in a large prospective U.S.-based cohort

Amina Chtourou; Lydia Marcus Post; Jared A Fisher; Rachael Stolzenberg-Solomon; Joel D Kaufman; Debra T Silverman; Rena R Jones

doi:10.1038/s41370-026-00929-9

Long-term exposure to outdoor air pollutants and risk of pancreatic cancer in a large prospective U.S.-based cohort

J Expo Sci Environ Epidemiol. 2026 Jun 16. doi: 10.1038/s41370-026-00929-9. Online ahead of print.

Authors

Amina Chtourou^{1

2}, Lydia Marcus Post^{3

4}, Jared A Fisher³, Rachael Stolzenberg-Solomon⁵, Joel D Kaufman⁶, Debra T Silverman³, Rena R Jones³

Affiliations

¹ Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics (DCEG), NCI, Rockville, MD, USA. amina.chtourou@nih.gov.
² Center for Global Health, NCI, Rockville, MD, USA. amina.chtourou@nih.gov.
³ Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics (DCEG), NCI, Rockville, MD, USA.
⁴ Cancer Prevention Fellowship Program, Division of Cancer Prevention, NCI, Rockville, MD, USA.
⁵ Metabolic Epidemiology Branch, DCEG, NCI, Rockville, MD, USA.
⁶ Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA.

PMID: 42303835
DOI: 10.1038/s41370-026-00929-9

Abstract

Background: Outdoor air pollutants have been inconsistently associated with pancreatic cancer incidence and mortality.

Objective: We investigated associations between outdoor fine particulate matter (PM_2.5) and nitrogen dioxide (NO₂) and pancreatic cancer risk.

Methods: We estimated historical pollutant concentrations at enrollment (1995-1996) residences in the NIH-AARP Diet and Health Study (N = 486,431). We estimated hazard ratios and 95% confidence intervals (HR [CI]) for associations (continuous and categorical) with incident pancreatic cancer overall (N = 4999) and pancreatic ductal adenocarcinomas (PDAC; N = 4708) in models adjusted for lifestyle and sociodemographic factors.

Results: We observed small, non-significant associations with pancreatic cancer overall (PM_2.5 ${HR}_{per 5 μ g / m^{3}}$ = 1.03[0.99-1.08]; NO₂ HR_{per 10 ppb} = 1.02[0.99-1.06]) and with PDAC (1.03[0.98-1.08]; 1.02[0.98-1.06], respectively). We found no exposure-response across categories (p-trend > 0.05). The PM_2.5 association was apparent only among participants aged 55-64 years at enrollment (p-interaction = 0.04).

Significance: Marginal associations between PM_2.5 and NO₂ and pancreatic cancer risk are consistent with a small number of prior studies.

Impact: This study builds on a small prior literature of associations between air pollution and pancreatic cancer risk. Our analyses in a large U.S.-based cohort revealed small, positive, but non-statistically significant associations between PM_2.5 and NO₂ and incident pancreatic cancer, and some heterogeneity was suggested by age. Future research incorporating enhanced exposure assessment across more demographically and geographically diverse populations may help to further elucidate these associations.

Keywords: Air pollution; Cancer; Particulate matter.