FIGURE 1.

The diverse involvement of cigarette smoking in PDAC development and progression is illustrated in this diagram. Both the direct and indirect roles smoking plays in PDAC development are included. The direct affects are numerous, whereas the indirect affects occur through the modulation and/or activation of the various risk factors, namely, having a history of diabetes, IPMN, chronic pancreatitis, obesity, genetic mutations, and alcohol consumption. In addition, as illustrated, genetic factors (as effected by smoking) influence PDAC directly, as well as indirectly by modulating other risk factors.