The incidence and mortality rates of pancreatic cancer increased in almost all countries and territories from 1990 to 2017 according to a systematic analysis performed within the Global Burden of Disease Study 2017. The study published online on 21 October 2019 in The Lancet Gastroenterology & Hepatology is the first effort to provide comprehensive worldwide estimates of the burden, epidemiological features, and risk factors of pancreatic cancer. With population growth and increases in longevity, clinicians and policy makers might expect a further substantial rise in the absolute number of pancreatic cancer cases, particularly in low-income and middle-income nations.
The authors explained evidence before this study as following:Pancreatic cancer was estimated as the seventh leading cause of cancer death in both sexes worldwide in 2018, on the basis of the Global Cancer Incidence, Mortality and Prevalence 2018 estimates, from 185 countries, using subregional rather than national data. Because of the poor prognosis of pancreatic cancer, there were almost as many deaths (432 000 in total) as there were cases (459 000). 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 south central 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.
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-standardised rates per 100 000 person-years.
In 2017, there were 448 000 incident cases of pancreatic cancer globally, of which 232 000 (51.9%) were in males. The age-standardised incidence rate was 5.0 per 100 000 person-years in 1990 and increased to 5.7 per 100 000 person-years in 2017.
There was a 2.3 times increase in number of deaths for both sexes from 196 000 in 1990 to 441 000 in 2017. There was a 2.1 times increase in DALYs due to pancreatic cancer, increasing from 4.4 million in 1990 to 9.1 million 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 per 100 000 person-years) and Uruguay (12.1 per 100 000 person-years). These countries also had the highest age-standardised 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 for males and at 75–79 years for females.
Age-standardised 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.
Examining trends of pancreatic cancer from 1990 to 2017 and comparisons across populations offers important information about the changing burden of pancreatic cancer to aid in the allocation of necessary resources at local levels to help control this lethal cancer.
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.
Existing data gaps are a major challenge for policy making at the regional and national scale. Future studies should explore the predictors of epidemiological trends to help policy makers implement cost-effective interventions for prevention, early detection, and control of pancreatic cancer.
The study was funded by Bill & Melinda Gates Foundation.
Reference
GBD 2017 Pancreatic Cancer Collaborators. 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.The Lancet Gastroenterology & Hepatology. Published online 21 October 2019. DOI: https://doi.org/10.1016/S2468-1253(19)30347-4