Researchers from the Faculty of Medicine at The Chinese University of Hong Kong (CU Medicine) have analysed the data on the incidence of pancreatic cancer and mortality in 48 countries or regions around the world. They found that for this type of cancer, which has an extremely aggressive disease nature and poor survival rate, there have been reports of an increasing trend in incidence and mortality in the last decade. Smoking, alcohol drinking, physical inactivity, metabolic factors, gender and age were closely related to the incidence of pancreatic cancer. It is worth noting that there was also an increasing trend in pancreatic cancer identified among individuals below the age of 50, in some countries or regions.

The research team believes the findings can raise public awareness on preventive measures like better management of chronic metabolic diseases and they also call for targeted strategies to reduce the burdens from pancreatic cancers. Study results have just been published in the renowned medical journal Gastroenterology.

Pancreatic cancer is the 7th leading cause of cancer death worldwide 

Globally, pancreatic cancer is the 12th most common cancer and the 7th leading cause of cancer mortality. In Hong Kong, it was placed 5th in the top 10 killing cancers in 2017 with 690 death cases, according to the Hong Kong Cancer Registry of the Hospital Authority.

The relatively low success rate of treatment of pancreatic cancer can be explained by the lack of appropriate screening and diagnostic approaches, the deep-seated position of the pancreas, difficulties in performing a tissue biopsy, its aggressive clinical course and its low response rate to radiotherapy or chemotherapy.

Collaboration with Peking University and The University of Melbourne

To evaluate the most recent 10-year epidemiologic trend in incidence and mortality of pancreatic cancer around the world, researchers from The Jockey Club School of Public Health and Primary Care and the Department of Surgery at CU Medicine collaborated with their partners from other top institutions like Peking University and The University of Melbourne in a large-scale global analysis.

They used data from the global cancer database to estimate pancreatic cancer incidence and mortality in different countries or regions, and compared the data using the Average Annual Percent Change (AAPC¹) - a measure of the overall changes in the number of new cases and deaths in the past 10 years. Data from the World Health Organization Global Heath Observatory were also extracted to examine the association between lifestyle and metabolic factors and pancreatic cancer incidence and mortality. Results are as follows:

Incidence and mortality trend among countries or regions

Many countries reported an increasing trend in both incidence and mortality for pancreatic cancer in the past decade, especially among women. For incidence, 17 countries showed an increasing trend in the female population including Japan (AAPC, 2.48) and South Korea (AAPC, 1.71). For mortality, 14 countries showed an increasing trend in the female population including the Philippines (AAPC, 5.83), Thailand (AAPC, 4.39) and Japan (AAPC, 1.41).

For Hong Kong, an increasing trend in mortality was also noted in both men and women with AAPC 1.97 and 2.68 respectively, while there was no such trend in incidence. 

Incidence trend among younger and older individuals

The incidence of pancreatic cancer increased in 18 countries among individuals 50 years or older and the most marked increase was observed in Iceland (AAPC for men, 7.83). However, there were also 8 countries which showed an increase in pancreatic cancer incidence among those younger than 50 years, including Germany (AAPC for women, 8.75) and the United Kingdom (AAPC for women, 4.72). Similar patterns were observed in individuals younger than 40 years, where the incidence increased in four countries like the Netherlands (AAPC for women, 11.07) and Canada (AAPC for women, 9.57).

Association with lifestyle, metabolic risk factors and the human development index

The higher incidence and mortality observed were associated with a higher prevalence of lifestyle and metabolic risk factors among the population, with alcohol drinking as the most crucial factor. Data also showed that the highest incidence and mortality tended to predominate in countries or regions with higher human development index, which is an index to measure the development in terms of life expectancy, education and per capita income of countries or regions.

The findings call for strategies for identifying and treating high-risk populations earlier

Mr. HUANG Jun Jie, first-author of the study and PhD candidate from The Jockey Club School of Public Health and Primary Care at CU Medicine, explained, “The overall increasing trend in the incidence and mortality of pancreatic cancer in the past decade indicates a growing prevalence of its risk factors including population aging, metabolic diseases and unhealthy lifestyle. The increasing trend in pancreatic cancer incidence among younger individuals is also notable. Besides genetic factors, obesity, alcohol consumption, smoking, physical inactivity and metabolic diseases might also have accounted for the increase. Individuals should take earlier action to control these factors in order to reduce their risk of suffering from pancreatic cancer.”

Professor Martin Chi Sang WONG, corresponding author of the study, from The Jockey Club School of Public Health and Primary Care at CU Medicine, stated, “Given the rise in incidence and mortality trends, treatment of pancreatic cancer based on pharmacotherapy and surgery should be assigned a top priority in policy agendas and clinical guidelines so as to reduce its associated mortality. More medical resources are also required to cope with the treatment and surveillance of patients diagnosed with pancreatic cancer in order to identify and treat high-risk populations as early as possible. We recommend that future global research should investigate the reasons behind these increasing trends, which could offer more insights into the disease cause.”

Details of the research findings can be found at https://www.gastrojournal.org/article/S0016-5085(20)35244-6/fulltext.

¹For example, if the AAPC of a country is 5, it means the incidence of that country increased 5% each year over the 10-year period.