Pancreatic cancer incidence and mortality on the rise globally

The incidence and mortality of pancreatic cancer are on the rise globally, particularly among women and individuals ≥50 years of age, but an increasing trend is also found in younger individuals in some countries.

Researchers from the Chinese University of Hong Kong (CUHK) and collaborators in mainland China and Australia analyzed trends in pancreatic cancer incidence and mortality using 10-year data from global or national registries involving 48 countries. In 2018, the global age-standardized rates for incidence and mortality were 4.8 and 4.4 per 100,000 persons, respectively, with a male-to-female ratio for incidence of 1.4:1. [Gastroenterology 2020, doi: 10.1053/j.gastro.2020.10.007]

“Many countries reported an increasing trend in both incidence and mortality for pancreatic cancer in the past decade, especially among women and those ≥50 years of age,” the researchers noted.

The incidence of pancreatic cancer increased among men in 14 countries (average annual percent change [AAPC], 8.85 to 0.41) and women in 17 countries (AAPC, 6.04 to 0.87). While most of these countries were in Europe, the most significant increases in Asia occurred in Thailand (AAPC, 4.48 for men), Japan (AAPC, 1.47 for men, 2.48 for women) and South Korea (AAPC, 1.71 for women).

The incidence was found to have increased in individuals aged ≥50 years in 18 countries (AAPC, 7.83 to 0.91), with the most marked increases reported in Europe. Among individuals aged <50 years, an increase in incidence was found in eight countries (AAPC, 8.75 to 2.82), while four countries showed an increase in incidence among individuals aged <40 years (AAPC, 11.07 to 8.31).

Increased mortality from pancreatic cancer was reported for men in eight countries (AAPC, 4.20 to 0.55) and women in 14 countries (AAPC, 5.83 to 0.78), with the most significant increases occurring in Europe. In Asia, the most significant increases were in the Philippines (AAPC, 4.20 for men, 5.83 for women), Thailand (AAPC, 4.13 for men, 4.39 for women) and Japan (AAPC, 1.41 for women).

In Hong Kong, increased mortality was also found in both men (AAPC, 1.97) and women (AAPC, 2.68).

“Countries with higher incidence and mortality were more likely to have higher prevalence of [risk factors such as] smoking, alcohol drinking, physical inactivity, obesity, hypertension, and high cholesterol,” the researchers noted.

Previous studies have, for example, shown that an estimated 11–32 percent of pancreatic cancer cases are attributable to smoking, while a history of binge drinking is associated with a 2.5-fold increase in risk of pancreatic cancer. [Int J Epidemiol 2015;44:186-198; Cancer Causes Control 2010;21:1047-1059] A meta-analysis showed a 19 percent and 13 percent increase in risk of pancreatic cancer in individuals with a body mass index of 30–35 kg/m² and 25–30 kg/m², respectively. [Arch Intern Med 2010;170:791-802]

“Another possible reason for the increase in incidence and mortality is a rising incidence of pancreatic cystic neoplasm, a new disease entity with increasing awareness in the past 2 decades,” the researchers noted. [Gut 2018;67:789-804]

“Given the rise in incidence and mortality, treatment of pancreatic cancer based on pharmacotherapy and surgery should be assigned a top priority in policy agendas and clinical guidelines, so as to reduce its associated mortality,” said corresponding author Professor Martin Wong of CUHK’s Jockey Club School of Public Health and Primary Care. “More medical resources are required to cope with the treatment and surveillance of patients diagnosed with pancreatic cancer and to identify and treat high-risk populations as early as possible.”