The global, regional, and national burden of pancreatic cancer and its attributable risk factors in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017

Abstract

Background: Worldwide, both the incidence and death rates of pancreatic cancer are increasing. Evaluation of pancreatic cancer burden and its global, regional, and national patterns is crucial to policy making and better resource allocation for controlling pancreatic cancer risk factors, developing early detection methods, and providing faster and more effective treatments.

Methods: Vital registration, vital registration sample, and cancer registry data were used to generate mortality, incidence, and disability-adjusted life-years (DALYs) estimates. We 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-standardised rates per 100 000 person-years. 95% uncertainty intervals (UIs) were reported for all estimates.

Findings: In 2017, there were 448 000 (95% UI 439 000-456 000) incident cases of pancreatic cancer globally, of which 232 000 (210 000-221 000; 51·9%) were in males. The age-standardised incidence rate was 5·0 (4·9-5·1) per 100 000 person-years in 1990 and increased to 5·7 (5·6-5·8) per 100 000 person-years in 2017. There was a 2·3 times increase in number of deaths for both sexes from 196 000 (193 000-200 000) in 1990 to 441 000 (433 000-449 000) in 2017. There was a 2·1 times increase in DALYs due to pancreatic cancer, increasing from 4·4 million (4·3-4·5) in 1990 to 9·1 million (8·9-9·3) in 2017. The age-standardised death rate of pancreatic cancer was highest in the high-income super-region across all years from 1990 to 2017. In 2017, the highest age-standardised death rates were observed in Greenland (17·4 [15·8-19·0] per 100 000 person-years) and Uruguay (12·1 [10·9-13·5] per 100 000 person-years). These countries also had the highest age-standardised death rates in 1990. Bangladesh (1·9 [1·5-2·3] per 100 000 person-years) had the lowest rate in 2017, and São Tomé and Príncipe (1·3 [1·1-1·5] 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 for males and at 75-79 years for females. Age-standardised pancreatic cancer deaths worldwide were primarily attributable to smoking (21·1% [18·8-23·7]), high fasting plasma glucose (8·9% [2·1-19·4]), and high body-mass index (6·2% [2·5-11·4]) in 2017.

Interpretation: 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 programmes for early detection and more effective treatment strategies for pancreatic cancer are needed.

Funding: Bill & Melinda Gates Foundation.

Figure 1

Levels and trends in age-standardised incidence and death rates of pancreatic cancer across 21 GBD regions by sex (A) The age-standardised incidence rates of pancreatic cancer in 2017. (B) The percentage change in age-standardised incidence rate of pancreatic cancer from 1990 to 2017. (C) The age-standardised death rates of pancreatic cancer in 2017. (D) The percentage change in age-standardised death rate of pancreatic cancer from 1990 to 2017. GBD=Global Burden of Diseases, Injuries, and Risk Factors Study.

Figure 2

Age-specific counts and rates of incident cases (A), deaths (B), and DALYs (C) of pancreatic cancer by sex, 2017 DALYs=disability-adjusted life-years.

Figure 3

Age-standardised rates of incidence (A) and death (B) of pancreatic cancer across 195 countries and territories in both sexes, 2017

Figure 4

Fraction of pancreatic cancer age-standardised deaths attributable to smoking, high fasting plasma glucose, and high body-mass index by region (A) and fraction of pancreatic cancer age-specific deaths attributable to smoking, high fasting plasma glucose, and high body-mass index by age group (B) for males and females, 2017

Figure 5

The trend in age-standardised death rates of pancreatic cancer across 21 GBD regions by SDI for both sexes combined, 1990–2017 For each region, points from left to right depict estimates from each year from 1990 to 2017. GBD=Global Burden of Diseases, Injuries, and Risk Factors Study. SDI=Socio-demographic Index.

Figure 6

The age-standardised death rates of pancreatic cancer across 195 countries and territories by SDI in both sexes, 2017 SDI=Socio-demographic Index.