Home Browse Trends in pancreatic cancer incidence and mortality in the United...
ALL Metrics
-
Views
-
Downloads
Get PDF
Get XML
Cite
Export
Track
▬
✚
Research Article

Trends in pancreatic cancer incidence and mortality in the United States from 2000 to 2019; a SEER based study

[version 1; peer review: 2 approved with reservations]
Oluseyi Abidoye
https://orcid.org/0000-0002-5666-6085
1, Young Min Cho
https://orcid.org/0000-0002-3762-2327
1, Sheena Bhushan1, Comfort Adewunmi1, Hasan Choudhury1
Oluseyi Abidoye
https://orcid.org/0000-0002-5666-6085
1, Young Min Cho
https://orcid.org/0000-0002-3762-2327
1, [...] Sheena Bhushan1, Comfort Adewunmi1, Hasan Choudhury1
PUBLISHED 05 Jan 2023
Author details Author details
OPEN PEER REVIEW
REVIEWER STATUS

This article is included in the Oncology gateway.

Abstract

Background:  The annual incidence and mortality rates of pancreatic cancer has been rising. We analyzed pancreatic cancer trends by demographics and geographic location.
Methods:  Data was obtained from the Surveillance, Epidemiology, and End Results (SEER) registry 17 were available to assess trends of pancreatic cancer incidence and mortality from 2000 to 2019.
Results:  The pancreatic cancer incidence and mortality rates consistently increased over time from 2000 to 2019. Incidence of pancreatic cancer was highest in males (14; 95% Cl, 13.9,14.1) and blacks (15.4 95% Cl,15.2, 15.6). The incidence was highest in Alaska (16.2; 95% Cl, 14.1, 18.5), and lowest in Utah (10.7; 95% Cl, 10.4, 11.0). Incidence increased at 0.85% per year (95% Cl, 0.76, 0.92; P < .001). Overall incidence increased significantly for all sex, race, stage sub-groups except for Blacks (APC of 0.04%; 95% Cl, -0.14, 0.22; P = 0.649), and American Indian/Alaska natives (APC of -0.22 %; 95% Cl, -1.33, 0.89; P= 0.679). There was an overall significant increase in incidence across all states except for Alaska. Incidence-based mortality of pancreatic cancer was highest in males (12.6; 95% Cl, 12.5,12.7) and blacks (14.1; 95% Cl, 13.9, 14.3). Mortality was highest in Alaska (15.1; 95% Cl, 13.1,17.3), and lowest in Utah (9.6; 95% Cl, 9.3,9.9). Mortality increased at 0.91% per year (95% Cl, 0.32, 1.50; P = .005). The overall incidence-based mortality increased significantly only in the males APC, 0.95% (95% Cl, 0.36, 1.54; P = 0.003), females APC 1.18 (95% Cl, 0.47, 1.89; P = 0.002) and whites APC 1.05% (95% Cl, 0.45, 1.66; P = 0.002). Furthermore, there was an overall significant increase in incidence-based mortality across all states except for Alaska, Hawaii and Washington.
Conclusion: Pancreatic cancer incidence and mortality rates increased overall but differed by demographics and geographic location.

Keywords

Pancreatic Cancer, Pancreatic cancer incidence, Pancreatic Incidence-based mortality, SEER database, Pancreatic cancer risk factors

Corresponding author: Oluseyi Abidoye
Competing interests: No competing interests were disclosed.
Grant information: The author(s) declared that no grants were involved in supporting this work.
Copyright:  © 2023 Abidoye O et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
How to cite: Abidoye O, Cho YM, Bhushan S et al. Trends in pancreatic cancer incidence and mortality in the United States from 2000 to 2019; a SEER based study [version 1; peer review: 2 approved with reservations]. F1000Research 2023, 12:15 (https://doi.org/10.12688/f1000research.122872.1) First published: 05 Jan 2023, 12:15 (https://doi.org/10.12688/f1000research.122872.1) Latest published: 05 Jan 2023, 12:15 (https://doi.org/10.12688/f1000research.122872.1)

Introduction

Pancreatic cancer (PC) is one of the deadliest malignancies accounting for the third leading cause of cancer deaths in the United States in both male and females1–3 and seventh leading cause of cancer deaths worldwide.3 The American Cancer Society’s estimates about 62,210 people (32,970 men and 29,240 women) will be diagnosed with pancreatic cancer and about 49,830 people (25,970 men and 23,860 women) will die of pancreatic cancer in the United States by 2022.1 Pancreatic cancer accounts for about 3% of all cancers in the US and about 7% of all cancer deaths. It is one of the most fatal malignancies evidenced by a five-year survival rate of 11%.4 In terms of sex and race, pancreatic cancer rates have been reported to be higher in among male and black population.

Pancreatic cancer can be sub-grouped based on the histology. About 95% of malignant neoplasms of the pancreas originate from the exocrine elements with ductal adenocarcinoma accounting for about 85% of all pancreatic neoplasms.5 Neuroendocrine tumors such as insulinoma, gastrinoma, glucagonoma, somatostatinoma, and non-functional islet cells tumors are less common histological types of pancreatic cancer.5 Approximately 60 to 70 percent of exocrine pancreatic cancers are localized to the head of the pancreas, while 20 to 25 percent are in the body/tail and the remainder involve the whole organ.6

Studies have identified modifiable risk factors have been associated with Pancreatic cancer such as Overweight, Obesity, Tobacco use, Cigarette smoking and diabetes especially pancreatic adenocarcinoma7,8,9 with limited data on risk factors associated with other pancreatic cancers.10

Typically, patients are initially symptom-free until tumor progression when they present with non-specific symptoms such as fatigue, abdominal pain, jaundice, and weight loss.11 Diagnosis most cases are incidental in nature with nonspecific imaging studies. Most times, diagnosis is missed because patients have an early-stage disease.12 Treatment entails surgery, chemotherapy and radiotherapy depending on the staging and extent of disease, with most cases treatment focused on symptom relief and improving survival as there are no definitive treatments for advanced disease.11,12

The lack of screening tests and high fatality makes pancreatic cancer a tremendous public health burden for the United States.12 Based on the high fatality and absence screening tests, a need for further research focusing on interventions directed at disease prevention, treatment, and patient outcomes.

A trend analysis of incidence and mortality rate of pancreatic cancer is focused on highlighting the burden of pancreatic cancer and emphasize the importance of formulating preventive strategies geared at reducing pancreatic cancer incidence and mortality. Our study focused on obtained data from National Cancer Institute (NCI) from the Surveillance, Epidemiology, and End Results (SEER) database13 and highlights the incidence and incidence-based mortality trends from 2000-2019.

The SEER program of the NCI has been involved in collecting data on cancer epidemiology.13 Several studies have analyzed and assessed trends in pancreatic cancer rates.14,15 However, most reports have varied in conclusions with recent data. Most of these reports used SEER database as their only database. Our study further focused on stratifying pancreatic cancer incidence rates and incidence mortality-based rates based on age, sex, race and state.

Methods

We used SEER*stat software 8.4.0.116 to obtain data of pancreatic cancer cases diagnosed from 2000 to 2019 from SEER eighteen registries. “Incidence - SEER Research Plus Data, 17 Registries, Nov 2021 Sub (2000-2019). The SEER 17 data is based on 26.5% of the U.S. population based on 2010 census. The study included patients diagnosed with pancreatic cancer from 2000 to 2019; We used International Classification of Disease (ICD)-0-2 and ICD-0-3 for coding for pancreatic cancer.17,18 We excluded cases whose diagnosis relied only on autopsy or death certificates. We focused on the following variables: sex, race, age and stage at diagnosis, site of the tumor within the pancreas and geographical location.

The rates are available by expanded race/ethnicity of cases diagnosed, including white, black, Asian/Pacific Islander, and American Indian/Alaskan Native and Hispanic ethnicity. SEER 17 also includes adjustments for areas impacted by hurricanes Katrina and Rita. It contains a record for each of 8,131,919 tumors. The registries included in SEER 17 are Alaska Natives, San Francisco Oakland SMSA, Connecticut, Hawaii, Iowa, New Mexico, Seattle (Puget Sound), Utah, Atlanta, (Metropolitan, San Jose-Monterey, Los Angeles, Rural Georgia, California excluding San Francisco, San Jose Monterey, Los Angeles, Kentucky, Louisiana, New Jersey, Greater Georgia.

We calculated two main outcomes: incidence and incidence-based mortality rates. All rates were adjusted to the 2000 US Standard population and expressed by 100, 000 person-years. These rates were calculated from 2000 to 2019 according to demographic and tumor characteristics. Incidence-based mortality rates were calculated as the number of pancreatic cancer deaths among cases diagnosed over person-time at risk among people in the SEER areas. We then calculated the Annual percentage changes (APC) of incidence and incidence-based mortality rates over the study period according to the baseline demographic and tumor characteristics.

We used SEER*stat software 8.4.0.1 to calculate the incidence and incidence-based mortality rates. We also used the NCI’s Joinpoint Regression Program, version 4.9.1.019,20 to calculate the APCs. The Joinpoint Regression software uses t-tests to determine if APCs were statistically significant from zero; a difference was noted to be statistically significant when P < 0.05. The software analyzed rates over time and detected significant changes in the APCs, then selected the best model with the minimum number of joinpoints. All statistical tests were two-sided.

Results

Baseline Characteristics

We obtained data of 206,968 cases with pancreatic cancer during 2000 – 2019 period. (Table 1). Majority of these patients were white (148,321 subjects [80.87%]), Male (92,438 ejects 50.40%]), older than 60 (152,764 subjects [83.29%]) and had metastatic disease at diagnosis (86,578 subjects [41.83%]). In terms of geographic location, California state had the highest subjects of 75,532 (41.18%).

Table 1. Pancreatic cancer incidence rates (2000 – 2019).

CharacteristicsIncidence of Pancreatic cancer
Cases, No (%)aRate (95% Cl)b
Overall206,968 (100)12.3 (12.3 – 12.4)
Sex  
Male104,364 (50.43)14 (13.9-14.1)
Female102,604 (49.57)10.9 (10.9 – 11)
Race  
White166,650 (80.52)12.3 (12.2 – 12.3)
Black23,050 (11.14)15.4 (15.2 – 15.6)
Asian or Pacific Islander15,467 (7.47)9.9 (9.8 – 10.1)
American Indian/Alaska native1,261 (0.61)7.7 (7.3 – 8.2)
Unknownc540 (0.26) 
Age at diagnosis  
<60 years42,405 (20.49)2.9 (2.8 – 2.9)
>60 years164,563 (79.51)60.2 (59.9 – 60.5)
Stated  
Alaska243 (0.11)16.2 (14.1-18.5)
California85,604 (41.36)11.7 (11.6 – 11.8)
Connecticut11,355 (5.49)13.4 (13.1-13.6)
Georgia22,339 (10.79)12.4 (12.2 – 12.6)
Hawaii4,212 (2.04)13.1 (12.7-13.5)
Iowa9,235 (4.46)12.5 (12.2-12.7)
Kentucky12,014 (5.81)12.5 (12.2-12.7)
Louisiana13,062 (6.31)13.7 (13.4-13.9)
New Jersey27,295 (13.19)13.6 (13.5 – 13.8)
New Mexico4,894 (2.37)10.9 (10.6 – 11.3)
Utah4,565 (2.21)10.7 (10.4 – 11.0)
Washington12,150 (5.87)12.7 (12.4 – 12.9)
Stage at diagnosis  
Localized19,922 (9.63)1.2 (1.2-1.2)
Regional49,254 (23.80)2.9 (2.9-2.9)
Distant86,578 (41.83)5.1 (5.1-5.2)
Unstaged19,461 (9.40)1.2 (1.2-1.2)
Blank(s)e31,753 (15.34)1.9 (1.9 – 1.9)

a Cases reported from the SEER registry

b Rates were calculated as the number of cases per 100,000 person-years and age-adjusted to the 2000 US standard population

c Rates for patients with unknown race could not be calculated, as ‘race’ is a population variable and must be known to calculate rates

d Rates were calculated using Using SEER registry variable between 2000 – 2018 for all states, with Georgia and California subdivided based on region

e Using SEER Summary stage 2000

We also reviewed data of 183,406 cases of patients who died from pancreatic cancer based on incidence-based mortality analysis from 2000 – 2019 period (Table 2). Most of the patients were male (92,438 subjects [50.40%]), White (148,321 subjects [80.87%]), older than 60 (152,764 subjects [83.29%]) and had a metastatic disease (87,142 subjects [40.91%]). Figure 1 shows the incidence and incidence-based mortality trends for Pancreatic Cancer from 2000-2019.

Table 2. Pancreatic cancer incidence-based mortality rates (2000-2019).

CharacteristicsIncidence of Pancreatic cancer
Cases, No (%) aRate (95% Cl) b
Overall183,406(100)11 (10.9 – 11)
Sex  
Male92,438 (50.40)12.6 (12.5-12.7)
Female90,968 (49.60)9.6 (9.6 – 9.7)
Race  
White148,321 (80.87)10.9 (10.9 – 11)
Black20,554 (11.21)14.1 (13.9 – 14.3)
Asian or Pacific Islander13,104 (7.14)8.6 (8.4 – 8.7)
American Indian/Alaska native1,132 (0.62)7.2 (6.8 – 7.7)
Unknownc295 (0.16) 
Age at diagnosis  
<60 years30,642 (16.71)2 (2 – 2.1)
>60 years152,764 (83.29)56.1 (55.8 – 56.4)
Stated  
Alaska222 (0.12)15.1 (13.1-17.3)
California75,532 (41.18)10.4 (10.3 – 10.5)
Connecticut10,039 (5.47)11.7 (11.5-12)
Georgia19,899 (10.85)11.2 (11.1 – 11.4)
Hawaii3,758 (2.04)11.6 (11.2-11.9)
Iowa8,315 (4.53)11.1 (10.9-11.3)
Kentucky10,855 (5.91)11.3 (11.1-11.5)
Louisiana11,860 (6.47)12.5 (12.3-12.7)
New Jersey23,875 (13.02)11.9 (11.7 – 12.1)
New Mexico4,397 (2.40)9.9 (9.6 – 10.2)
Utah4,040 (2.20)9.6 (9.3 – 9.9)
Washington10,614 (5.79)11.2 (11 – 11.4)
Stage at diagnosis  
Localized13,511 (6.38)0.8 (0.8-0.8)
Regional45,178 (21.91)2.7 (2.7-2.7)
Distant87,142 (40.91)5.2 (5.1-5.2)
Unstaged21,934 (10.76)1.3 (1.3-1.3)
Blank(s)e15,641 (20.04)2.2 (2.2 – 2.2)

a Cases reported from the SEER registry

b Rates were calculated as the number of cases per 100,000 person-years and age-adjusted to the 2000 US standard population

c Rates for patients with unknown race could not be calculated, as ‘race’ is a population variable and must be known to calculate rates

d Rates were calculated using Using SEER registry variable between 2000 – 2018 for all states, with Georgia and California subdivided based on region

e Using SEER Summary stage 2000

b7326d46-030a-4783-8db1-f51546437fec_figure1.gif

Figure 1. Temporal trends in (a) age-standardized pancreatic cancer incidence and (b) incidence-based mortality —SEER 17 (2000-2019).

*Indicates that the Annual percentage Change (APC) is significantly different from zero at the alpha =0.05 level.

Incidence rates and trends over time

The overall pancreatic incidence during the study period was 12.3 per 100,000 person-years (95% confidence interval [Cl], 12.3, 12.4). Incidence of pancreatic cancer was highest in males (14; 95% Cl, 13.9,14.1), black subjects (15.4 95% Cl,15.2, 15.6), and people older than 60 years (60.2; 95% Cl, 59.9, 60.5). In terms of geographical location, the incidence was highest in Alaska (16.2; 95% Cl, 14.1, 18.5), and lowest in Utah (10.7; 95% Cl, 10.4, 11.0) compared to other states. Based on the stage at diagnosis, distant stage had the highest incidence (5.1; 95% Cl, 5.1, 5.2). (Table 1)

Over the study period, pancreatic incidence rates increased at 0.85% per year (95% Cl, 0.76, 0.92; P < .001). Rates did increase but were not significant during periods 2000-2003; APC, 0.71% (95% Cl, -0.56, 2.0 P = 0.248) and 2003-2006; APC, 1.74% (95% Cl, -0.71, 4.26, P= 0.149, but significantly increased by 0.68% (95% Cl, 0.56, 0.80; P < 0.001) per year during 2006 – 2019. The overall incidence rates increased significantly for all sex, race, age at diagnosis and stage at diagnosis except for Black subjects (APC of 0.04%; 95% Cl, -0.14, 0.22; P = 0.649), and American Indian/Alaska native subjects (APC of -0.22 %; 95% Cl, -1.33, 0.89; P= 0.679). Furthermore, there was an overall significant increase in incidence rates across all states except for Alaska. (file 3) Table 3 describes the pancreatic cancer incidence trends from 2000 – 2019 by sex, race, stage and age at diagnosis. Table 5 pancreatic cancer incidence trends from 2000 – 2019 by geographical location. Figure 2 shows the incidence trends based on sex, race and stage; Figure 3 shows the incidence trends based on state.

Table 3. Trend showing the Incidence of Pancreatic Cancer (2000-2019).

Overall (2000 – 2019)Trends
123
APC a(95%Cl)P-value bYearAPC a (95%Cl)P-value bYearAPC a (95% Cl)P-value bYearAPC a (95% Cl)P-value b
Overall0.85 (0.76 – 0.92)<0.0012000-20030.71 (-0.56-2.0)0.2482003-20061.74 (-0.71-4.26)0.1492006-20190.68 (0.56 – 0.80)<0.001
Sex           
Male0.84 (0.74-0.94)<0.0012000-20030.21 (-1.57-2.02)0.8062003-20071.59 (-0.14-3.36)0.0682007-20190.66 (0.47 – 0.86)<0.001
Female0.75 (0.64 – 0.86)<0.0012000-20051.65 (0.60 – 2.72)0.0052005-20170.54 (0.31 – 0.78)<0.0012017 – 20191.35 (-0.69 – 3.44)0.176
Race           
White0.97 (0.86 – 1.07)<0.0012000-20030.93 (-0.64-2.51)0.2232003-20061.88 (-1.13-4.99)0.2012006-20190.79 (0.64 – 0.93)<0.001
Black0.04 (-0.14 – 0.22)0.6492000 – 20051.08 (-0.63-2.81)0.1952005-2011-0.65 (-2.29 – 1.02)0.4122011-20190.31 (-0.40 – 1.03)0.355
American Indian/Alaska native-0.22 (-1.33 – 0.89)0.6792000-2013-0.96 (-3.14 – 1.28)0.3672013-20167.84 (-22.87 – 50.78)0.6332016 – 2019-10.33 (-24.01 – 5.81)0.177
Asian or Pacific Islander0.52 (0.25 – 0.78)0.0012000-2003-1.58 (-6.41-3.50)0.5042003-20101.40 (-0.06-2.88)0.0592010-20190.07 (-0.57 – 0.71)0.827
Age at Diagnosis           
< 60 years1.32(1.15 – 1.49)<0.0012000-20071.80 (0.89-2.71)0.0012007-20100.66 (-5.30-6.98)0.8192010-20191.33 (0.81 – 1.86)<0.001
> 60 years0.72 (0.64 – 0.81)<0.0012000-20030.67 (-0.46-1.81)0.2232003-20061.65 (-0.55-3.90)0.1302006-20190.55 (0.45 – 0.65)<0.001
Stage at Diagnosis           
Localized5.09 (4.60-5.57)<0.0012000-20076.81 (4.42-9.25)<0.0012007-20101.02 (-14.71-19.67)0.8982010-20195.91 (4.29 – 7.56)<0.001
Regional1.56 (1.24 – 1.89)<0.0012000 – 2003-0.02 (-2.92-2.95)0.9862003-20103.22 (2.20-4.25)<0.0012010 – 20190.22 (-0.31– 0.76)0.387
Distant0.67 (0.48-0.86)<0.0012000 – 20052.07 (-1.16-2.98)<0.0012005-20140.41 (-0.02-0.85)0.0612014-20190.15 (-0.74 – 1.05)0.717
b7326d46-030a-4783-8db1-f51546437fec_figure2.gif

Figure 2. Temporal trends in age-standardized pancreatic cancer incidence by sex, racial group and stage—SEER 17 (2000-2019).

*Indicates that the Annual percentage Change (APC) is significantly different from zero at the alpha =0.05 level.

b7326d46-030a-4783-8db1-f51546437fec_figure3.gif

Figure 3. Temporal trends in age-standardized pancreatic cancer incidence by state —SEER 17, (2000-2019).

*Indicates that the Annual percentage Change (APC) is significantly different from zero at the alpha =0.05 level.

Incidence-Based Mortality Rates and Trends Overtime

The overall pancreatic incidence-based mortality during the study period was 11 per 100,000 person-years (95% Cl, 10.9,11). Incidence-based mortality of pancreatic cancer was highest in males (12.6; 95% Cl, 12.5,12.7), black subjects (14.1; 95% Cl, 13.9, 14.3), and people older than 60 years (56.1; 95% Cl, 55.8,56.4). In terms of geographical location, incidence-based mortality was highest in Alaska (15.1; 95% Cl, 13.1,17.3), and lowest in Utah (9.6; 95% Cl, 9.3,9.9) compared to other states. Based on the stage at diagnosis, distant staging (5.2; 95% Cl, 5.1, 5.2) had the highest incidence-based mortality compared to stage sub-groups. (Table 2).

Over the study period, pancreatic incidence-based mortality rates increased at 0.91% per year (95% Cl, 0.32, 1.50; P = .005). There was a significant steep increase from 2000 – 2002 period; APC, 21.57% (95% Cl, 15.88, 27.88 P <0.001), followed by a gradual increase in 2002-2007; APC, 1.02 % (95% Cl, -0.12, 2.17, P= 0.075) which was not significant; However, 2007 – 2019 period increased by 0.27% per year which was significant (95% Cl, 0.07, 0.47; P = 0.013). The overall incidence-based mortality rates increased significantly only in the male subjects APC, 0.95% (95% Cl, 0.36, 1.54; P = 0.003), female subjects APC 1.18 (95% Cl, 0.47, 1.89; P = 0.002) and white subjects APC 1.05% (95% Cl, 0.45, 1.66; P = 0.002) and age at diagnosis. Even though there was an increase in the other subgroups, the increase was not significant. Furthermore, there was an overall significant increase in incidence-based mortality rates across all states except for Alaska, Hawaii and Washington. Table 4 describes the pancreatic cancer incidence-based mortality trends from 2000 – 2019 by sex, race, age at diagnosis and stage. Table 6 pancreatic cancer incidence-based mortality trends from 2000 – 2019 by geographical location.

Table 4. Trend showing the Incidence based mortality of Pancreatic Cancer (2000-2019).

Overall (2000 – 2019)Trends
123
APC a(95%Cl)P-value bYearAPC a (95%Cl)P-value bYearAPC a(95% Cl)P-value bYearAPC a(95% Cl)P-value b
Overall0.91 (0.32 – 1.50)0.0052000-200221.57 (15.88-27.88)<0.0012002-20071.02 (-0.12-2.17)0.0752007-20190.27 (0.07 – 0.47)0.013
Sex           
Male0.95 (0.36-1.54)0.0032000-200219.33 (11.54-27.66)<0.0012002-20071.37 (-0.19-2.95)0.0792007-20190.25 (-0.02 – 0.52)0.066
Female1.18 (0.47 – 1.89)0.0022000-200228.78 (18.21 – 40.29)< 0.0012002-2005-1.13 (-12.22 – 11.36)0.8382005 – 20190.35 (0.03 – 0.68)0.037
Race           
White1.05 (0.45 – 1.66)0.0022000 – 200221.82 (15.24 – 28.78)<0.0012002-20071.40 (0.17-2.65)0.0292007-20190.35 (0.13 – 0.56)0.004
Black0.26 (-0.44 – 0.97)0.4452000 – 200225.27 (8.20 – 45.03)0.0062002-2012-0.88 (-1.94 – 0.19)0.0972012-20190.50 (-0.85 – 1.86)0.437
American Indian/Alaska native0.32 (-0.97 – 1.64)0.6082000-200312.39 (-16.02 – 50.40)0.4002003-2012-1.19 (-6.17 – 4.05)0.6222012 – 20190.82 (-4.29 – 6.21)0.737
Asian or Pacific Islander0.42 (-0.19 – 1.03)0.1672000-200220.70 (1.91-42.95)0.0322002-20120.47 (-0.52-1.47)0.3182012-2019-0.77 (-1.98 – 0.46)0.197
Age at Diagnosis           
< 60 years1.32 (1.15 – 1.49)<0.0012000-200237.62 (26.60-49.59)<0.0012002-20090.17 (-1.23-1.59)0.7982009-2019-0.34 (-0.99 – 0.31)0.272
> 60 years0.72 (0.64 – 0.81)<0.0012000-200223.55 (19.55 – 27.68)<0.0012002-20070.83 (-0.21-1.89)0.1082007-20190.42 (0.23 – 0.62)<0.001
Stage at Diagnosis           
Localized1.73 (-1.30-4.86)0.2492000-200335.26 (22.66-49.15)<0.0012003-20172.03 (0.99-3.08)0.0012017-2019-44.77 (-54.58 – -32.84)<0.001
Regional0.94 (-1.65 – 3.60)0.4602000 – 200246.93 (33.19-62.09)<0.0012002-20171.66 (1.19-2.13)<0.0012017-2019-40.79 (-46.33– - 34.68)<0.001
Distant-3.17 (-7.16-0.99)0.1252000 – 200221.17 (14.46-28.27)<0.0012002-20170.67 (0.40-0.94)<0.0012017-2019-67.36 (-69.17 – - 65.45)<0.001

Table 5. Trend showing the Incidence of Pancreatic Cancer per State (2000-2019).

Overall (2000 – 2019)Trends
123
APC a (95%Cl)P-value bYearAPC a (95%Cl)P-value bYearAPC a (95% Cl)P-value bYearAPC a (95% Cl)P-value b
Alaska0.21 (-2.55 – 3.04)0.8782000-2014-2.35 (-6.32 – 1.79)0.2362014-201726.53 (-46.52-198.79)0.5622017-2019-39.30 (-73.68 – 39.97)0.217
California0.59 (0.43-0.74)<0.0012000-20061.20 (0.15-2.66)0.0282006-20130.15 (-0.85-1.17)0.7482013-20190.88 (-0.09-1.86)0.071
Connecticut0.58 (0.11 – 1.04)0.0192000-20054.38 (0.91 – 7.96)0.0172005-2012-0.42 (-2.77 – 1.97)0.7042012 – 20190.25 (-1.40 – 1.94)0.745
Georgia1.14 (0.84 – 1.43)<0.0012000 – 20141.59 (1.03 – 2.14)<0.0012014-2017-0.83 (-10.68 – 10.11)0.8652014-20191.39 (-6.18 – 9.57)0.705
Hawaii0.67 (0.16 – 1.19)0.0142000 – 2002-3.19 (-18.03 – 14.33)0.6782002-20171.23 (0.52 – 1.93)0.0022017-2019-6.69 (-18.14 – 6.38)0.272
Iowa1.34 (0.96 – 1.73)<0.0012000-20070.29 (-1.58–2.19)0.7442007-20142.50 (0.33 – 4.72)0.0272014 – 2019-0.01 (-2.63 – 2.69)0.996
Kentucky1.58 (1.13 – 2.03)<0.0012000-20027.13 (-13.03-31.96)0.4862002-20141.68 (0.54-2.84)0.0072014-20190.39 (-2.97 – 3.87)0.806
Louisiana0.75 (1.15 – 1.49)0.0012000-20140.97 (0.32 – 1.62)0.0072014-2017-1.74 (-13.60-11.74)0.7712017-20195.26 (-6.30 – 18.24)0.356
New Jersey1.17 (0.92 – 1.42)<0.0012000-20050.12 (-2.30 – 2.61)0.9172005-20082.71 (-7.73 – 14.32)0.5972008-20190.99 (0.33 – 1.65)0.006
New Mexico0.72 (0.13-1.32)0.0192000 – 20110.17 (-1.59 – 1.96)0.8412011-20162.02 (-5.13 – 9.70)0.5602016-2019-0.37 (-11.09 – 11.65)0.945
Utah1.24 (0.63 – 1.86)<0.0012000 – 20122.21 (1.40-3.02)<0.0012012-2016-2.22 (-7.70-3.59)0.4132016-20194.68 (-0.90 – 10.58)0.094
Washington0.83 (0.47-1.19)<0.0012000 – 2004-1.87 (-6.43-2.92)0.4052004-20073.57 (-10.60-19.97)0.6132007-2019-0.58 (-0.16 –1.33)0.114

Table 6. Trend showing the Incidence based mortality of Pancreatic Cancer by state (2000-2019).

Overall (2000 – 2019)Trends
123
APC a (95%Cl)P-value bYearAPC a (95%Cl)P-value bYearAPC a (95% Cl)P-value bYearAPC a (95% Cl)P-value b
Alaska-0.15 (-2.43 – 2.19)0.8942000-2014-0.82 (-4.26 – 2.74)0.6212014-201712.64 (-40.70 113.95)0.6932017-2019-28.30 (-62.95 – 38.75)0.294
California1.25 (0.25-2.25)0.0162000-200225.55 (17.62 34.02)<0.0012002-20051.30 (-5.41-8.49)0.6882005-2019-0.08 (-0.38-0.22)0.576
Connecticut1.07 (0.10 – 2.05)0.0332000-200230.69 (8.31 – 57.69)0.0092002-20054.23 (-9.75 – 20.37)0.5432005 – 2019-0.15 (-0.79 – 0.49)0.611
Georgia1.44 (0.77 – 2.12)<0.0012000 – 200224.82 (1.84 – 53.00)0.0352002-20050.17 (-15.90 – 19.31)0.9842005-20190.97 (0.31 – 1.62)0.007
Hawaii0.77 (-0.04 – 1.59)0.0602000 – 200221.11 (-6.93 – 57.60)0.1392002-20170.44 (-0.49 – 1.37)0.3222017-2019-3.27 (-19.44 – 16.14)0.699
Iowa1.65 (1.10 – 2.20)<0.0012000-200219.57 (3.18–38.57)0.0222002-2005-0.38 (-11.80 – 12.52)0.9472005 – 20191.39 (0.85 – 1.93)<0.001
Kentucky1.79 (0.90 – 2.69)<0.0012000 – 200232.57 (-0.16-76.02)0.0512002-20141.39 (0.10-2.70)0.0372014-20190.39 (-3.52 – 4.45)0.835
Louisiana1.13 (0.43 – 1.84)0.0032000-200220.01 (0.19 – 43.76)0.0482002-20150.70 (-0.19-43.76)0.0482015-2019-0.29 (-4.61 – 4.23)0.889
New Jersey1.24 (0.60 – 1.88)0.0012000-200219.17 (3.45 – 37.29)0.0192002-20091.26 (-0.71 – 3.26)0.1912009-20190.46 (-0.34 – 1.26)0.236
New Mexico0.83 (0.15-1.51)0.0192000 – 200212.58 (-17.55 – 53.71)0.4232002-20160.71 (-0.55 – 1.98)0.2422016-2019-1.37 (-10.59 – 8.81)0.765
Utah1.41 (0.54 – 2.29)0.0032000 – 200229.92 (2.12 – 65.28)0.0362002-20131.61 (0.36-2.87)0.0162013-2019-0.79 (-3.06 – 1.55)0.016
Washington0.77 (-0.05-1.60)0.0632000 – 200223.60 (0.99-51.26)0.0412002-20090.87 (-1.72 – 3.53)0.4822009-2019-0.21 (-1.30 –0.90)0.687

Figure 4 shows the incidence-based mortality trends based on sex, race and stage at diagnosis; Figure 5 shows the incidence-based mortality trends based on state.

b7326d46-030a-4783-8db1-f51546437fec_figure4.gif

Figure 4. Temporal trends in age-standardized pancreatic cancer incidence-based mortality by sex, racial and stage—SEER 17, (2000-2019).

*Indicates that the Annual percentage Change (APC) is significantly different from zero at the alpha =0.05 level.

b7326d46-030a-4783-8db1-f51546437fec_figure5.gif

Figure 5. Temporal trends in age-standardized pancreatic cancer incidence-based mortality by state —SEER 17, (2000-2019).

*Indicates that the Annual percentage Change (APC) is significantly different from zero at the alpha =0.05 level.

Discussion

Our study highlighted on the trends of incidence and mortality rates of pancreatic cancer in the United States using a single comprehensive registry system from 2000 to 2019. Incidence rates of pancreatic carcinomas consistently increased over time from 2000 to 2019 but differed by gender, race, staging and geographical location. Pancreatic cancer incidence rates increased in all sex, race, stage and age at diagnosis except for Blacks and American Indian/Alaskan Native individuals, although rates of pancreatic cancer consistently were higher overall among the Black population. Such increases in rates of pancreatic cancer have also been observed internationally.21,22 Based on location, the incidence rates increased in most states except for Alaska and Hawaii; Alaska had the overall highest rates of pancreatic cancer incidence per state. Several studies have also reported increases in rates based on location as well.

The Pancreatic incidence-based mortality rates increased consistently in only males, females and white population; while with the other subgroups their incidence-based mortality rates remained relatively the same. Incidence-based mortality of pancreatic cancer was highest in males, black population and in Alaska. Regarding location, the incidence-based mortality rates increased across all states except for Alaska, Hawaii and Washington.

There are have been reported risk factors such as Obesity, Overweight, Tobacco smoking, Diabetes and Chronic pancreatitis that have been associated with Pancreatic Cancer.7,8,9,10 Tobacco smoking is a one of the established risk factors of Pancreatic Cancer.23,24 Several studies have showed a causal relationship with tobacco smoking especially with the number of cigarettes smoked with a study showing risk of pancreatic cancer decreasing by about 40% in two years after smoking cessation.

Vanessa L Gordon-Dseagu et al15 reported a decrease in incidence of pancreatic cancer from 1974 through 1990’s partly due to the drop in the rate of cigarette smoking in the mid-1960s. There has been a notable decline in smoking rates among all age groups, gender and racial/ethnic groups in recent decades but regardless of this decline; pancreatic cancer incidence has been rising steadily. This increase incidence of pancreatic cancers may be related to an increasing prevalence of obesity and overweight. The rate of prevalence of obesity and overweight continues to increase in the United states.25Studies have attributed steady increase in pancreatic cancer incidence to prevalence of obesity and overweight.9

Based on a recent study25, prevalence rates of overweight/obesity have been highest among Male and Black populations; these rates reflect higher pancreatic cancer incidence rates in among these groups. Furthermore, Asian populations have lower pancreatic cancer rates and this may be due to their the low prevalence of obesity and overweight compared with other racial groups.

Diabetes Mellitus has been reported to be associated with pancreatic cancer.8,27–29 It has been reported that abnormalities in glucose metabolism, insulin resistance and deficiency have been associated with pancreatic cancer. A recent meta-analysis reported a higher relative risk for pancreatic cancer associated with diabetes compared to the non-diabetics.26 These studies are further supported with the increase in prevalence rates of diabetes. The prevalence of diabetes was higher in Male population compared to female population as well as Black population compared other racial groups.25 This could be a contributory factor associated with the increase trends of pancreatic cancer incidence.

Overall, the incidence and mortality rates of pancreatic cancer increased consistently from 2000-2019. Our observations are consistent with similar studies done during different time periods. There was a study that focused on pancreatic adenocarcinoma from 1973 to 2014, reporting similar results with our study. Our study focused on all pancreatic cancers from 2000 to 2019. As noted from previous study, there was an overall increase in the incidence and incidence-based mortality rates of pancreatic cancers during the study group.

One of the strengths of our study was use of large population-based database, with SEER 21 covering approximately 26.5% of the US population. This allowed us the opportunity to analyze the recent pancreatic cancer rates. Our study had several limitations due to limited available date from SEERs. Because of the limitations with SEERs database, we were unable to compare factors associated with pancreatic cancer such as lifestyle habits or co-morbidities which prevented us from identifying a direct association between such factors and the incidence and mortality of pancreatic cancer.

Conclusion

Pancreatic cancer incidence and mortality rates have been increasing in recent decades in the USA. We analyzed incidence and mortality rates by sex, race, age, staging, and geographic location. The increasing incidence trends may be attributed to an increase in known risk factors such as smoking, obesity, and diabetes; Health professionals and health policymakers should make a conscious effort in reducing these factors by creating initiatives and efforts at curbing these factors such as awareness, advocating for healthy lifestyles. The increasing mortality trends can be correlated to multiple factors such as late detection and diagnosis. Improvements in early detection, diagnosis and management may reduce the mortality rate over time.

Additional file 1, shows the incidence rates in each individual year from 2000 to 2019.

Additional file 2 shows pancreatic cancer incidence-based mortality rates in each individual year from 2000 to 2019.

Contribution

Abidoye O: Conceptualization, Investigation, Methodology, Project Administration, Resources, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing; Cho Y: Supervision, Writing – Original Draft Preparation, Writing – Review & Editing; Bhushan S: Writing – Original Draft Preparation; Adewunmi C: Validation; Choudhury H: Validation

Conflict-of-interest disclosure

The authors declare no financial interests.

Data Availability

All data underlying the results are available as part of the article and no additional source data are required.

Reference

  • 1.  Cancer Facts & Figures: American Cancer Society (ACS), Atlanta, Georgia.2022; 2022.
  • 2.  Howlader N, Noone AM, Krapcho M, et al.: SEER Cancer Statistics Review, 1975-2018. Bethesda, MD:National Cancer Institute.
  • 3.  Sung H, Ferlay J, Siegel RL, et al.: Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J. Clin. 2021 May; 71(3): 209–249. Epub 2021 Feb 4. PubMed Abstract | Publisher Full Text
  • 4.  Siegel RL, Miller KD, Fuchs HE, et al.: Cancer Statistics, 2021. CA Cancer J. Clin. 2021 Jan; 71(1): 7–33. Epub 2021 Jan 12. Erratum in: CA Cancer J. Clin. 2021 Jul;71(4):359. PubMed Abstract | Publisher Full Text
  • 5.  Zhou J, Enewold L, Stojadinovic A, et al.: Incidence rates of exocrine and endocrine pancreatic cancers in the United States. Cancer Causes Control. 2010 Jun; 21(6): 853–861. Epub 2010 Feb 25. Erratum in: Cancer Causes Control. 2011 Sep;22(9):1353. PubMed Abstract | Publisher Full Text
  • 6.  Modolell I, Guarner L, Malagelada JR: Vagaries of clinical presentation of pancreatic and biliary tract cancer. Ann. Oncol. 1999; 10 Suppl 4: 82–84. PubMed Abstract | Publisher Full Text
  • 7.  Siegel RL, Jacobs EJ, Newton CC, et al.: Deaths due to cigarette smoking for 12 smoking-related cancers in the United States. JAMA Intern. Med. 2015; 175: 1574–1576. PubMed Abstract | Publisher Full Text
  • 8.  Kamisawa T, Wood LD, Itoi T, et al.: Pancreatic cancer. Lancet Lond Engl. 2016; 388: 73–85. Publisher Full Text
  • 9.  Stolzenberg-Solomon RZ, Schairer C, Moore S, et al.: Lifetime adiposity and risk of pancreatic cancer in the NIH-AARP Diet and Health Study cohort. Am. J. Clin. Nutr. 2013; 98: 1057–1065. PubMed Abstract | Publisher Full Text
  • 10.  Ilic M, Ilic I: Epidemiology of pancreatic cancer. World J. Gastroenterol. 2016; 22: 9694–9705. PubMed Abstract | Publisher Full Text
  • 11.  McGuigan A, Kelly P, Turkington RC, et al.: Pancreatic cancer: A review of clinical diagnosis, epidemiology, treatment and outcomes. World J. Gastroenterol. 2018 Nov 21; 24(43): 4846–4861. PubMed Abstract | Publisher Full Text | Free Full Text
  • 12.  Zhang L, Sanagapalli S, Stoita A: Challenges in diagnosis of pancreatic cancer. World J. Gastroenterol. 2018 May 21; 24(19): 2047–2060. PubMed Abstract | Publisher Full Text | Free Full Text
  • 13.  Surveillance Research Program, NCIs Division of Cancer Control and Population Sciences: SEER Registries.20 march 2021. SEER*Stat Databases: November 2019 Submission (cancer.gov)
  • 14.  Ali H, Pamarthy R, Vallabhaneni M, et al.: Pancreatic cancer incidence trends in the United States from 2000-2017: Analysis of Surveillance, Epidemiology and End Results (SEER) database. F1000Res. 2021 Jul 2; 10: 529. PubMed Abstract | Publisher Full Text | Free Full Text
  • 15.  Gordon-Dseagu VL, Devesa SS, Goggins M, et al.: Pancreatic cancer incidence trends: evidence from the Surveillance, Epidemiology and End Results (SEER) population-based data. Int. J. Epidemiol. 2018 Apr 1; 47(2): 427–439. PubMed Abstract | Publisher Full Text | Free Full Text
  • 16.  Surveillance Research Program, National Cancer Institute: SEER*Stat software. version 8.4.0.1.
  • 17.  Percy C, Van Holten V, Muir C: ICD- O International Classification of Diseases for Oncology. 2nd ed.Geneva:World Health Organization.1990.Reference Source
  • 18.  Fritz A, Percy C, Jack A, et al.: ICD-O International Classification of Diseases for Oncology. 3rd ed.Geneva:World Health Organization.Reference Source
  • 19.  National Cancer Institute, Statistical Methodology and Applications Branch, Surveillance Research Program: Joinpoint Regression Program, Version 4.9.1.0—April 2022.
  • 20.  Kim HJ, Fay MP, Feuer EJ, et al.: Permutation tests for Joinpoint regression with applications to cancer rates. Stat. Med. 2000; 19: 335–351. PubMed Abstract | Publisher Full Text
  • 21.  Lin Q-J: Current status and progress of pancreatic cancer in China. World J. Gastroenterol. 2015; 21: 7988–8003. PubMed Abstract | Publisher Full Text
  • 22.  Wong MCS, Jiang JY, Liang M, et al.: Global temporal patterns of pancreatic cancer and association with socioeconomic development. Sci. Rep. 2017; 7: 3165. PubMed Abstract | Publisher Full Text
  • 23.  Stolzenberg-Solomon RZ, Amundadottir LT: Epidemiology and inherited predisposition for sporadic pancreatic adenocarcinoma. Hematol. Oncol. Clin. North Am. 2015; 29: 619–640. PubMed Abstract | Publisher Full Text
  • 24.  Silverman DT, Hoover RN, Brown LM, et al.: Why do Black Americans have a higher risk of pancreatic cancer than White Americans? Epidemiol. Camb. Mass. 2003; 14: 45–54. PubMed Abstract | Publisher Full Text
  • 25.  Arispe IE, Gindi RM, Madans JH: Health, United States, 2019. National Center for Health Statistics (U.S.);2021.Reference Source
  • 26.  Batabyal P, Vander Hoorn S, Christophi C, et al.: Association of diabetes mellitus and pancreatic adenocarcinoma: a meta-analysis of 88 studies. Ann. Surg. Oncol. 2014; 21(7): 2453–2462. PubMed Abstract | Publisher Full Text
  • 27.  Carreras-Torres R, Johansson M, Gaborieau V, et al.: The Role of Obesity, Type 2 Diabetes, and Metabolic Factors in Pancreatic Cancer: A Mendelian Randomization Study. J. Natl. Cancer Inst. 2017; 109(9): djx012. Publisher Full Text
  • 28.  Michaud DS, Liu S, Giovannucci E, et al.: Dietary sugar, glycemic load, and pancreatic cancer risk in a prospective study. J. Natl. Cancer Inst. 2002; 94(17): 1293–1300. Publisher Full Text
  • 29.  Wolpin BM, Bao Y, Qian ZR, et al.: Hyperglycemia, insulin resistance, impaired pancreatic β-cell function, and risk of pancreatic cancer. J. Natl. Cancer Inst. 2013; 105(14): 1027–1035. PubMed Abstract | Publisher Full Text

Comments on this article Comments (0)

Version 1
VERSION 1 PUBLISHED 05 Jan 2023
Comment
Author details Author details
Competing interests
Grant information
Article Versions (1)
Copyright
Download
 
Export To
metrics
Views Downloads
F1000Research - -
PubMed Central
Data from PMC are received and updated monthly.
 - -
Citations
SEE MORE DETAILS
CITE
how to cite this article
Abidoye O, Cho YM, Bhushan S et al. Trends in pancreatic cancer incidence and mortality in the United States from 2000 to 2019; a SEER based study [version 1; peer review: 2 approved with reservations]. F1000Research 2023, 12:15 (https://doi.org/10.12688/f1000research.122872.1)
NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.
track
receive updates on this article
Track an article to receive email alerts on any updates to this article.

Open Peer Review

Current Reviewer Status: ?
Key to Reviewer Statuses VIEW
ApprovedThe paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approvedFundamental flaws in the paper seriously undermine the findings and conclusions
Version 1
VERSION 1
PUBLISHED 05 Jan 2023
Views
1
Cite
Reviewer Report 19 Aug 2025
Thomas Seufferlein, Department of Internal Medicine I, Ulm University Hospital, Ulm, Germany 
Approved with Reservations
VIEWS 1
https://doi.org/10.5256/f1000research.134920.r400945
In their paper the authors describe incidence rates of pancreatic carcinomas between 2000 and 2019 and report differences by gender, race,  geographical location and age. Pancreatic cancer has still a dismal prognosis and this is clearly shown by comparing the ... Continue reading
CITE
CITE
HOW TO CITE THIS REPORT
Seufferlein T. Reviewer Report For: Trends in pancreatic cancer incidence and mortality in the United States from 2000 to 2019; a SEER based study [version 1; peer review: 2 approved with reservations]. F1000Research 2023, 12:15 (https://doi.org/10.5256/f1000research.134920.r400945)
The direct URL for this report is:
https://f1000research.com/articles/12-15/v1#referee-response-400945
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
Report a concern
Views
1
Cite
Reviewer Report 24 Oct 2023
Haleh Amirian, Department of Surgery, University of Miami, Miami, FL, USA 
Approved with Reservations
VIEWS 1
https://doi.org/10.5256/f1000research.134920.r212936
Well-written and informative retrospective study using SEER database looking at incidence and incidence-based mortality of pancreatic cancer through the years and among different racial groups, genders, stages, and states in the US. However, the results has not been fully discussed ... Continue reading
CITE
CITE
HOW TO CITE THIS REPORT
Amirian H. Reviewer Report For: Trends in pancreatic cancer incidence and mortality in the United States from 2000 to 2019; a SEER based study [version 1; peer review: 2 approved with reservations]. F1000Research 2023, 12:15 (https://doi.org/10.5256/f1000research.134920.r212936)
The direct URL for this report is:
https://f1000research.com/articles/12-15/v1#referee-response-212936
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
Report a concern

Comments on this article Comments (0)

Version 1
VERSION 1 PUBLISHED 05 Jan 2023
Comment

Open Peer Review

Reviewer Status

Alongside their report, reviewers assign a status to the article:

Approved
The paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations
A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approved
Fundamental flaws in the paper seriously undermine the findings and conclusions

Reviewer Reports

Invited Reviewers
1 2
Version 1
05 Jan 23 		read read
  1. Haleh Amirian, University of Miami, Miami, USA
  2. Thomas Seufferlein, Ulm University Hospital, Ulm, Germany

Comments on this article

All Comments(0)

Add a comment
Sign up for content alerts

Browse by related subjects

    keyboard_arrow_left Back to all reports
    keyboard_arrow_left Back to all reports
    Alongside their report, reviewers assign a status to the article:
    Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested
    Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
    Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions
    Sign In
    If you've forgotten your password, please enter your email address below and we'll send you instructions on how to reset your password.

    The email address should be the one you originally registered with F1000.
    Email address not valid, please try again

    You registered with F1000 via Google, so we cannot reset your password.

    To sign in, please click here.

    If you still need help with your Google account password, please click here.

    You registered with F1000 via Facebook, so we cannot reset your password.

    To sign in, please click here.

    If you still need help with your Facebook account password, please click here.

    Code not correct, please try again
    Email us for further assistance.
    Server error, please try again.