Epidemiology of Pancreatic Cancer: Global Trends, Etiology and Risk Factors

Abstract

Pancreatic cancer is the seventh leading cause of cancer-related deaths worldwide. However, its toll is higher in more developed countries. Reasons for vast differences in mortality rates of pancreatic cancer are not completely clear yet, but it may be due to lack of appropriate diagnosis, treatment and cataloging of cancer cases. Because patients seldom exhibit symptoms until an advanced stage of the disease, pancreatic cancer remains one of the most lethal malignant neoplasms that caused 432,242 new deaths in 2018 (GLOBOCAN 2018 estimates). Globally, 458,918 new cases of pancreatic cancer have been reported in 2018, and 355,317 new cases are estimated to occur until 2040. Despite advancements in the detection and management of pancreatic cancer, the 5-year survival rate still stands at 9% only. To date, the causes of pancreatic carcinoma are still insufficiently known, although certain risk factors have been identified, such as tobacco smoking, diabetes mellitus, obesity, dietary factors, alcohol abuse, age, ethnicity, family history and genetic factors, Helicobacter pylori infection, non-O blood group and chronic pancreatitis. In general population, screening of large groups is not considered useful to detect the disease at its early stage, although newer techniques and the screening of tightly targeted groups (especially of those with family history), are being evaluated. Primary prevention is considered of utmost importance. Up-to-date statistics on pancreatic cancer occurrence and outcome along with a better understanding of the etiology and identifying the causative risk factors are essential for the primary prevention of this disease.

Keywords: Epidemiology; Etiology; Incidence; Mortality; Pancreatic cancer; Pancreatitis; Prevention; Risk factors; Survival; Trends.

Figure 1

Map shows estimated age-standardized incidence rates (ASR) for pancreatic cancer worldwide in 2018, including both sexes and all ages (reproduced from http://globocan.iarc.fr/ [2]).

Figure 2

(a) Bar chart shows country-specific incidence age-standardized rates by sex for pancreatic cancer in 2018. Source: GLOBOCAN 2018 [2]. (b) Bar chart shows country-specific mortality age-standardized rates by sex for pancreatic cancer in 2018. Source: GLOBOCAN 2018 [2].

Figure 3

Map shows estimated age-standardized mortality rates (ASR) for pancreatic cancer worldwide in 2018, including both sexes and all ages (reproduced from http://globocan.iarc.fr/ [2]).

Figure 4

Bar chart shows estimated age-standardized incidence and mortality rates (ASR) for pancreatic cancer in world areas in 2018, including both sexes and all ages (reproduced from http://globocan.iarc.fr/ [2]).

Figure 5

Trends in pancreatic cancer incidence and mortality predicted for the years 2018 to 2040 (reproduced from http://globocan.iarc.fr/ [28]). (a) Estimated incidence from 2018 to 2040, in both sexes and all ages (0 - 70+ years). Asia: 214,499 in 2018 and +190,532 in 2040, (+88.8% of increase); Europe: 132,559 in 2018 and +38,855 in 2040 (+29.3%); North America: 56,002 in 2018 and +28,325 in 2040 (+50.6%); Africa: 16,059 in 2018 and +18,327 in 2040 (+114.1%); Latin America and the Caribbean: 35,270 in 2018 and +35,007 in 2040 (+99.3%); Oceania: 4,529 in 2018 and +3,268 in 2040 (+72.2%). (b) Estimated mortality from 2018 to 2040, in both sexes and all ages (0 to 70+ years). Asia: 200,681 in 2018 and +182,127 in 2040 (+90.8%); Europe: 128,045 in 2018 and +40,444 in 2040 (+31.6%); North America: 50,745 in 2018 and +29,011 in 2040 (57.2%); Africa: 15,458 in 2018 and +17,744 in 2040 (+114.8%); Latin America and the Caribbean: 33,311 in 2018 and +33,637 in 2040 (+101.0%); Oceania: 4,002 in 2018 and +2,985 in 2040 (74.6%)

Figure 6

Pancreatic cancer, age-standardized 1-year and 5-year net survival, adults (age: 15 - 99 years), England and Wales 1971 - 2011 (reproduced from reference [34]).