Chapter 12: Cancer of the Pancreas

The Burden of Digestive Diseases in the United States

James E. Everhart, M.D., M.P.H.

In 2004, 71 percent of newly diagnosed pancreatic cancers were among persons age 65 years and older (Table 1). Age at diagnosis was higher than for most other digestive system cancers, with the median being 72 years and 40 percent diagnosed at age 75 years or older (PDF, 28KB) .

Incidence rates were highest among the elderly, non-Hispanic blacks, and males. Age-adjusted incidence was relatively stable from 1979 to 2004, being essentially the same in the first and last year (Figure 1). Survival from pancreatic cancer is the poorest of any major cancer, digestive system or otherwise. Nevertheless, 5-year survival increased modestly from 2 percent among persons diagnosed in 1979 to 3.8 percent among persons diagnosed in 1999.

In 2004, there were an estimated 415,000 ambulatory care visits for pancreatic cancer and 68,000 hospital discharges with a diagnosis of pancreatic cancer (Table 2). Hospitalization rates were highest among the elderly and age-adjusted rates were higher for blacks and males. While ambulatory care visits appear to have increased from 1992 through 2004, hospital discharge rates were stable from 1979 through 2004 (Figure 2).

Because of low survival, pancreatic cancer mortality was essentially the same as incidence in 2004. As underlying cause, there were 31,800 deaths in 2004 (third highest of all digestive diseases) and more than 200,000 YPLL prior to age 75 years (also third highest of all digestive diseases) (Table 3). Rates were highest in the oldest age group. Age-adjusted mortality rates were higher for blacks and for males. Death rates for pancreatic cancer remained steady between 1979 and 2004 (Figure 3).

Table 1. Pancreatic Cancer: Number of Cases and Incidence Rates by Age, Race/Ethnicity, and Sex, 2004

Source: Surveillance, Epidemiology, and End Results (SEER) Program

Demographic Characteristics Number of Cases Incidence per 100,000 Unadjusted Incidence per 100,000 Age-Adjusted
AGE (Years)
Under 15
AGE (Years)
15–44
878 0.7
AGE (Years)
45–64
9,513 13.6
AGE (Years)
65+
21,681 63.4
RACE/ETHNICITY
Non-Hispanic White
25,873 13.5 11.2
RACE/ETHNICITY
Non-Hispanic Black
3,614 10.6 15.2
RACE/ETHNICITY
Hispanic
1,929 4.8 10.4
RACE/ETHNICITY
Asian/Pacific Islander
947 7.7 9.2
RACE/ETHNICITY
American Indian/Alaska Native
99 5.3 8.1
Sex
Female
15,709 10.8 10.0
Sex
Male
14,853 10.6 12.7
Total 30,560 10.7

Figure 1. Pancreatic Cancer: Age-Adjusted Incidence Rates and 5-Year Survival Rates, 1979–2004

Incidence per 100,000 was relatively stable from 1979 to 2004, being essentially the same in the first and last years at 11.5. Five-year survival increased modestly from 2.03 percent in 1979 to 3.76 percent in 1999, the last year for which it could be calculated.
Source: Surveillance, Epidemiology, and End Results (SEER) Program

Table 2. Pancreatic Cancer: Number and Age-Adjusted Rates of Ambulatory Care Visits and Hospital Discharges With First-Listed and All-Listed Diagnoses by Age, Race, and Sex in the United States, 2004

Source: National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) (3-year average, 2003–2005), and Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP NIS)

Demographic Characteristics Ambulatory Care Visits First-Listed Diagnosis Number in Thousands Ambulatory Care Visits First-Listed Diagnosis Rate per 100,000 Ambulatory Care Visits All-Listed Diagnosis Number in Thousands Ambulatory Care Visits All-Listed Diagnosis Rate per 100,000 Hospital Discharges First-Listed Diagnosis Number in Thousands Hospital Discharges First-Listed Diagnosis Rate per 100,000 Hospital Discharges All-Listed Diagnosis Number in Thousands Hospital Discharges All-Listed Diagnosis Rate per 100,000
AGE (Years)
Under 15
AGE (Years)
15–44
1 1 2 2
AGE (Years)
45–64
154 218 162 229 12 16 23 33
AGE (Years)
65+
230 634 251 690 21 59 43 119
Race
White
383 148 409 158 28 11 55 21
Race
Black
4 15 8 30
Sex
Female
214 129 237 144 17 10 34 20
Sex
Male
173 124 178 128 17 13 34 26
Total 386 132 415 141 34 12 68 23

Figure 2. Pancreatic Cancer: Age-Adjusted Rates of Ambulatory Care Visits and Hospital Discharges With All–Listed Diagnoses in the United States, 1979–2004

The rate of ambulatory care visits over time (age-adjusted to the 2000 U.S. population) is shown by 3-year periods (except for the first period which is 2 years), between 1992 and 2005 (beginning with 1992–1993 and ending with 2003–2005). Ambulatory care visits per 100,000 appear to have increased from 32.9 in 1992-1993 to 137 in 2003-2005. Hospitalizations per 100,000 were stable at 22.8 in 1979 and 20.8 in 2004.
Source: National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) (averages 1992–1993, 1994–1996, 1997–1999, 2000–2002, 2003–2005), and National Hospital Discharge Survey (NHDS)

Table 3. Pancreatic Cancer: Number and Age-Adjusted Rates of Deaths and Years of Potential Life Lost (to Age 75) by Age, Race, and Sex in the United States, 2004

Source: Vital Statistics of the United States

Demographic Characteristics Underlying Cause Number of Deaths Underlying Cause Rate per 100,000 Underlying Cause Years of Potential Life Lost in Thousands Underlying or Other Cause Number of Deaths Underlying or Other Cause Rate per 100,000
AGE (Years)
Under 15
1 0.0
AGE (Years)
15–44
596 0.5 20.6 606 0.5
AGE (Years)
45–64
8,407 11.9 147.9 8,656 12.2
AGE (Years)
65+
22,796 62.7 38.2 23,825 65.6
Race
White
27,247 10.5 167.8 28,323 10.9
Race
Black
3,681 13.7 31.9 3,848 14.3
Sex
Female
16,004 9.2 83.3 16,602 9.6
Sex
Male
15,796 12.4 123.5 16,487 12.9
Total 31,800 10.8 206.8 33,089 11.3

Figure 3. Pancreatic Cancer: Age-Adjusted Rates of Death in the United States, 1979–2004

Death rates remained steady between 1979 and 2004. Underlying-cause mortality per 100,000 was 10.6 in 1979 and 10.5 in 2004. All-cause mortality per 100,000 was 11.4 in 1979 and 10.9 in 2004.
Source: Vital Statistics of the United States
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