The incidence and mortality rates of pancreatic cancer have increased in 195 countries and territories over a 27-year period, according to a systematic analysis performed within the Global Burden of Disease Study 2017 and published in The Lancet Gastroenterology & Hepatology. The study is the first effort to provide comprehensive worldwide estimates of the burden, epidemiologic features, and risk factors of pancreatic cancer.
Background
Pancreatic cancer was estimated as the seventh-leading cause of cancer death in both sexes worldwide in 2018, according to the Global Cancer Incidence, Mortality and Prevalence 2018 estimates from 185 countries using subregional rather than national data. In 2018, there were an estimated 432,000 global deaths due to pancreatic cancer and approximately 459,000 cases of the disease. The rates reported were three times to four times higher in higher Human Development Index countries, with incidence rates being highest in Europe, North America, Australia, and New Zealand, and lowest in central south Asia. There were no estimates of temporal patterns, trends, age patterns, years of life lost, disability-adjusted life-years (DALYs), and associated risk factors of pancreatic cancer at national, regional, global, and socioeconomic levels before the Global Burden of Disease Study.
Current Study
In the current study, vital registration, vital registration sample, and cancer registry data were used to generate mortality, incidence, and DALYs estimates. The study team used the comparative risk assessment framework to estimate the proportion of deaths attributable to risk factors for pancreatic cancer: smoking, high fasting plasma glucose, and high body mass index. All of the estimates were reported as counts and age-standardized rates per 100,000 person-years.
Results
In 2017, there were 448,000 incident cases of pancreatic cancer globally, 232,000 (51.9%) of which were in males. The age-standardized incidence rate was 5.0 per 100,000 person-years in 1990, and it increased to 5.7 per 100,000 person-years in 2017. There was also an increase in DALYs due to pancreatic cancer, increasing from 4.4 million in 1990 to 9.1 million in 2017.
The age-standardized death rate of pancreatic cancer was highest in the high-income superregion across all years from 1990 to 2017. In 2017, the highest age-standardized death rates were observed in Greenland (17.4 per 100,000 person-years) and Uruguay (12.1 per 100,000 person-years). These countries also had the highest age-standardized death rates in 1990. Bangladesh (1.9 per 100,000 person-years) had the lowest rate in 2017, and São Tomé and Príncipe (1.3 per 100,000 person-years) had the lowest rate in 1990.
The numbers of incident cases and deaths peaked at the ages of 65–69 years old for males and at 75–79 years old for females.
Age-standardized pancreatic cancer deaths worldwide were primarily attributable to smoking (21.1%), high fasting plasma glucose (8.9%), and high body mass index (6.2%) in 2017.
The authors concluded, “Globally, the number of deaths, incident cases, and DALYs caused by pancreatic cancer has more than doubled from 1990 to 2017. The increase in incidence of pancreatic cancer is likely to continue as the population ages. Prevention strategies should focus on modifiable risk factors. Development of screening programs for early detection and more effective treatment strategies for pancreatic cancer are needed.”
Disclosure: The study was funded by Bill & Melinda Gates Foundation. For full disclosures of the study authors, visit thelancet.com.
