The observed nicotine-induced changes in p-ERK, p-Src, p-CREB, p-AKT and caspase-3 in xenograft tissues and in vitro are in accord with reports describing mechanisms of nicotine-induced pancreatic cancer cell proliferation [18], inhibition of apoptosis [10, 21] and increase in gemcitabine resistance [21, 22]. Here, CREB1 is linked to familial pancreatic carcinoma.