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.

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.

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.

Last Reviewed January 2008

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