The relation between pancreatic cancer and alcohol consumption was investigated in a case-control study conducted in Milan, Northern Italy, between 1983 and 1992 on 361 incident histologically confirmed cases and 997 controls admitted to hospital for acute nonneoplastic diseases apparently unrelated to alcohol and tobacco consumption. Compared with teetotalers, the multivariate odds ratio (OR) of pancreatic cancer, after adjustment for age, sex, education, smoking status, and history of diabetes, pancreatitis, and cholelithiasis, were 0.9 for alcohol drinkers and 0.9, 1.1, 1.4, and 1.1 for those who consumed up to four, more than four to seven, more than seven to eight, or more than eight alcoholic drinks per day; none of the estimates or the trend in risk was significant. OR were also close to unity in the separate analysis of wine, beer, and spirit intake, with no trend in risk, and no relationship was observed for duration of use (OR = 0.7 for > 40 yrs of use). No interaction was observed between pancreatic cancer and total alcohol intake in separate strata of age, sex, education, and smoking status. Thus the findings of the present study, on the basis of a population with relatively frequent and high alcohol consumption, provide epidemiologic evidence that even high alcohol intake does not appreciably modify the risk of pancreatic cancer.