European Journal of Epidemiology

, Volume 18, Issue 8, pp 801–816 | Cite as

International variation in pancreatic cancer mortality for the period 1955–1998

  • A.E. Sahmoun
  • R.A. D'Agostino Jr
  • R.A. Bell
  • D.C. Schwenke


Background: Pancreatic cancer is an important cause of cancer mortality in developed countries. This article examines time trends for pancreatic cancer mortality rates in 38 countries on five continents between 1955 and 1998. Methods: We used the World Health Organization database on Age-Standardized World Population pancreatic cancer mortality rates by gender and fitted these data with linear regression models. This allowed us to (1) investigate the statistical significance of temporal trends; and (2) consider differences in trends among countries; and (3) predict future pancreatic cancer mortality rates. Results: Over 44 years, pancreatic cancer mortality rates increased for females worldwide. Pancreatic cancer mortality rates for men increased in Southern Europe. In contrast, pancreatic cancer mortality rates for men in North America and Oceania increased until about 1975 and then decreased or remained stable. Ourpredictive models suggest that by 2005 the relative burden of pancreatic cancer mortality will have shifted away from Northern Europe and North America toward Southern Europe and Asia. Conclusions: Future research on pancreatic cancer should concentrate separately on the assessment of risk attributable to exposure to environmental factors, lifestyle factors, genetic determinates of pancreatic cancer, and the interactive influences of these factors on pancreatic cancer.

Epidemiology International comparisons Pancreatic cancer Predicted mortality Time trends 


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  1. 1.
    Pisani P, Parkin DM, Munoz N, et al. Cancer and infection: Estimates of the attributable fraction in 1990. Cancer Epidem Biomarkers Prevent 1997; 6: 387–400.Google Scholar
  2. 2.
    Schwartz GG, Reis IM. Is cadmium a cause of human pancreatic cancer? Cancer Epidem Biomarkers Prevent 2000; 9: 139–145.Google Scholar
  3. 3.
    Rosenberg L. Treatment of pancreatic cancer. Int J Pancreatol 1997; 22: 81–93.Google Scholar
  4. 4.
    Flanders TY, Foulkes WD. Pancreatic adenocarcinoma: Epidemiology and genetics. J Med Genet 1996; 33: 8889–8898.Google Scholar
  5. 5.
    Zheng T, Holford TR, Ward BA, et al. Time trend in pancreatic cancer incidence in Connecticut, 1935-1990. Int J Cancer 1995; 61: 622–627.Google Scholar
  6. 6.
    Lin Y, Tamakoshi A, Wakai K, et al. Descriptive epidemiology of pancreatic cancer in Japan. J Epidemiol 1998; 8: 52–59.Google Scholar
  7. 7.
    Nomiyama K, Ueda K, Kiyohara Y, et al. Malignant neoplasms in the Japanese community of Hisayama: Mortality and changing pattern during a 30-year observation period based on a consecutive autopsy series. J Clin Epidemiol 1996; 49: 45–50.Google Scholar
  8. 8.
    Adanja B, Gledovic Z, Pekmezovic T, et al. Mortality trends of malignant tumours of digestive organs in Belgrade, Yugoslavia, 1975-1997. Digest Liver Dis 2000; 32: 386–391.Google Scholar
  9. 9.
    Conrath SM. The validity of determining pancreatic cancer incidence in the United States by the use of mortality data. Regul Toxicol Pharm 1987; 7: 43–56.Google Scholar
  10. 10.
    Lee WC, Lin RS. Age-period-cohort analysis of pancreatic cancer mortality in Taiwan, 1971-1986. Int J Epidemiol 1990; 19: 839–847.Google Scholar
  11. 11.
    Kato I, Kuroishi T, Tominaga S. Descriptive epidemiology of subsites of cancer of the liver, biliary tract and pancreas in Japan. Jpn J Clin Oncol 1990; 20: 232–237.Google Scholar
  12. 12.
    Vutuc C, Waldhoer Th, Haidinger G. Impact of noninvasive imaging techniques on the trend of pancreatic cancer mortality in Austria. Wien Med Wschr 1996; 146: 258–260.Google Scholar
  13. 13.
    Hirayama T. Epidemiology of pancreatic cancer in Japan. Jpn J Clin Oncol 1989; 19: 208–215.Google Scholar
  14. 14.
    Lin RS, Lee WC. Mortality trends of pancreatic cancer: An affluent type of cancer in Taiwan. J Formosan Med Assoc 1992; 91: 1148–1153.Google Scholar
  15. 15.
    Fernandez E, La vecchia C, Porta M, et al. Trends in pancreatic cancer mortality in Europe, 1955-1989. Int J Cancer 1994; 57: 786–792.Google Scholar
  16. 16.
    Franceschi S, Levi F, Lucchini F, et al. Trends in cancer mortality in young adults in Europe, 1955-1989. Eur J Cancer 1994; 30A: 2096–2118.Google Scholar
  17. 17.
    Tominaga S, Kuroishi T. Epidemiology of pancreatic cancer. Semin Surg Oncol 1998; 15: 3–7.Google Scholar
  18. 18.
    Czernichov P, Lerebours E, Hecketsweiler et al. Epidemiologie temporo-spatiale du cancer du pancreas. Gastroenterol Clin Biol 1985; 9: 767–775.Google Scholar
  19. 19.
    Levi F, Decarli A, La vecchia C. Trends in cancer mortality in Switzerland, 1951-1984. Rev Epidem et Sante Publ 1988; 36: 15–25.Google Scholar
  20. 20.
    Moolgavkar SH, Stevens RG. Smoking and cancers of bladder and pancreas: Risks and temporal trends. J Natl Cancer Inst 1981; 67: 15–23.Google Scholar
  21. 21.
    Garvin AT, O'Reilly D. Cancer in Northern Ireland by 2002. Ulster Med J 1996; 65: 106–112.Google Scholar
  22. 23.
    Doll R, Smith PG. Comparison between registries: Age-standardized rates. In: Waterhouse JAH, Muir CS, Shanmugaratnam K, Powell J, Peachman D, Whelan S (eds), Cancer Incidence in five Continents, Vol. IV, IARC Scientific Publication 42. Lyon: IARC, 1982; 671–675.Google Scholar
  23. 24.
    Black RJ, Bray F, Ferlay J, et al. Cancer incidence and mortality in the European Union: Cancer registry data and estimates of the national incidence for 1990. Eur J Cancer 1997; 33: 1075–1107.Google Scholar
  24. 25.
    Kleinbaum DG, Kupper LL, Muller KE, et al. Applied Regression Analysis and other Multivariable Methods. 3rd ed. London: Duxbury Press, 1998.Google Scholar
  25. 26.
    Coughlin SS, Calle EE, Patel AV, et al. Predictors of pancreatic cancer mortality among a large cohort of United States adults. Cancer Causes Control 2000; 11: 915–923.Google Scholar
  26. 27.
    Fernandez E, La vecchia C, Decarli A. Attributable risks for pancreatic cancer in northern Italy. Cancer Epidem Biomarkers Prevent 1996; 5: 23–27.Google Scholar
  27. 28.
    Silverman DT. Risk factors for pancreatic cancer: A case-control study based on direct interviews. Teratogen Carcinogen Mutagen 2001; 21: 7–25.Google Scholar
  28. 29.
    Zheng W, Mclaughlin JK, Gridley G, et al. A cohort study of smoking, alcohol consumption, and dietary factors for pancreatic cancer (United States). Cancer Causes Control 1993; 4: 477–482.Google Scholar
  29. 30.
    Kalapothaki V, Tzonou A, Hsieh CC, et al. Tobacco, ethanol, coffee, pancreatitis, diabetes mellitus, and cholelithiasis as risk factors for pancreatic carcinoma. Cancer Causes Control 1993; 4: 375–382.Google Scholar
  30. 31.
    Howe GR, Jain M, Burch JD, Miller AB. Cigarette smoking and cancer of the pancreas: Evidence from a population-based case-control study in Toronto, Canada. Int J Cancer 1991; 47: 323–328.Google Scholar
  31. 32.
    Mack TM, Yu MC, Hanisch R, et al. Pancreas cancer and smoking, beverage consumption, and past medical history. J Natl Cancer Inst 1986; 76: 49–60.Google Scholar
  32. 33.
    Silverman DT, Dunn JA, Hoover RN, et al. Cigarette smoking and pancreas cancer: A case-control study based on direct interviews. J Natl Cancer Inst 1994; 86: 1510–1516.Google Scholar
  33. 34.
    Gold EB, Gordis L, Diener MD, et al. Diet and other risk factors for cancer of the pancreas. Cancer 1985; 55: 460–467.Google Scholar
  34. 35.
    Garfinkel L. Trends in cigarette smoking in the United States. Prev Med 1997; 26: 447–450.Google Scholar
  35. 36.
    Enstrom JE. Smoking cessation and mortality trends among two United States populations. J Clin Epidemiol 1999; 52: 813–825.Google Scholar
  36. 37.
    Birkett NJ. Trends in smoking by birth cohort by births between 1940 and 1975: A reconstructed cohort analysis of the 1990 Ontario Health Survey. Prev Med 1997; 26: 534–541.Google Scholar
  37. 38.
    Osler M, Prescott E, Gottschau A, et al. Trends in smoking prevalence in Danish adults, 1964-1994. Scand J Soc Med 1998; 4: 293–298.Google Scholar
  38. 39.
    Everhart J, Wright D. Diabetes mellitus as a risk factor for pancreatic cancer. A meta-analysis. JAMA 1995; 273: 1605–1669.Google Scholar
  39. 40.
    Brancati FL, Wang NY, Mead LA, et al. Body weight patterns from 20 to 49 years of age and subsequent risk for diabetes mellitus: The Johns Hopkins Precursors Study. Arch Intern Med 1999; 159: 957–963.Google Scholar
  40. 41.
    Moller H, Mellemgaard A, Lindvig K, et al. Obesity and cancer risks: A Danish record-linkage study. Eur J Cancer 1994; 30A: 344–350.Google Scholar
  41. 42.
    Zatonski W, Przewozniak K, Howe GR, et al. Nutritional factors and pancreatic cancer: A case-control study from south-west Poland. Int J Cancer 1991; 48: 390–394.Google Scholar
  42. 43.
    Saw WM, Rajan U. Epidemiology of obesity: A review. Ann Acad Med Singapore 1997; 26(4): 489–493.Google Scholar
  43. 44.
    Burke JP, Williams K, Gaskill SP, et al. Rapid rise in the incidence of type 2 diabetes from 1987 to 1996: Results from the San Antonio Heart Study. Arch Intern Med 1999; 159: 1450–1456.Google Scholar
  44. 45.
    King H, Rewers M. Diabetes in adults is now a Third World Problem. World Health Organization Ad Hoc Diabetes Reporting Group. Ethnicity Disease 1993; Suppl 3: S67–S74Google Scholar
  45. 46.
    Noy A, Bilezikian JP. Clinical review 63: Diabetes and pancreatic cancer: Clues to the early diagnosis of pancreatic malignancy. J Clin Endocrinol Metab 1994; 79: 1223–1231.Google Scholar
  46. 47.
    Yankaskas BC, Staab EV, Rudnick SA, et al. The radiologic diagnosis of pancreatic cancer: the effect of new imaging techniques. Invest Radiol 1985; 20: 73–78.Google Scholar
  47. 48.
    Warshaw LA, Fernandez-Del Castillo C. Pancreatic carcinoma. N Engl J Med 1992; 326(7): 455–465.Google Scholar
  48. 49.
    Niederau C, Grendell JH. Diagnosis of pancreatic carcinoma. Imaging techniques and tumor markers. Pancreas 1992; 7: 66–86.Google Scholar
  49. 50.
    Malats N, Real FX, Porta M. DDT and pancreatic cancer. J Natl Cancer Inst 1993; 85: 328–329.Google Scholar
  50. 51.
    Lyon JL, Robison LM, Moser R. Uncertainty in the diagnosis of histologically confirmed pancreatic cases. Int J Epidemiol 1989; 18: 305–308.Google Scholar
  51. 52.
    Nieman JL, Holmes FF. Accuracy of diagnosis of pancreatic cancer decreases with increasing age. J Am Geriatr Soc 1989; 37: 97–100.Google Scholar
  52. 53.
    Spilker B. Worldwide comparability of diagnostic criteria. Drugs News Persp 1992; 6: 406–413.Google Scholar
  53. 54.
    Schadt ME, Kline TS, Neal HS, et al. Intraoperative pancreatic fine needle aspiration biopsy. Results in 166 patients. Am Surg 1991; 57: 73–75.Google Scholar
  54. 55.
    Ojajarvi A, Partanen TJ, Ahlbom A, et al. Occupational exposures and pancreatic cancer: A meta-analysis. Occup Environ Med 2000; 57: 316–324.Google Scholar
  55. 56.
    Weiderpass E, Partanan T, Kaaks R, et al. Occurrence, trends, and environmental etiology of pancreatic cancer. Scand J Work Environ Health 1998; 24(3): 165–174.Google Scholar
  56. 57.
    Lyon JL, Mahoney AW, French TK, et al. Coffee consumption and the risk of cancer of the exocrine pancreas: A case-control study in a low-risk population. Epidemiology 1992; 3: 164–170.Google Scholar
  57. 58.
    Fernandez E, La vecchia C, Porta M, et al. Pancreatitis and the risk of pancreatic cancer. Pancreas 1995; 11: 185–189.Google Scholar

Copyright information

© Kluwer Academic Publishers 2003

Authors and Affiliations

  • A.E. Sahmoun
    • 1
  • R.A. D'Agostino Jr
    • 1
  • R.A. Bell
    • 1
  • D.C. Schwenke
    • 2
  1. 1.Department of Public Health SciencesWake Forest University School of MedicineUSA
  2. 2.School of Health Administration and PolicyArizona State UniversityTempeUSA

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