Death Rates From Pancreatic Cancer Continue To Climb: Most Other Cancers Declining In Europe

In In The News by Barbara Jacoby

Thumbnail for 5798By: Robert Glatter, MD


Based on a new study published in the journal Annals of Oncology on April 23, 
death rates in Europe from pancreatic cancer continue to increase in both men and women in 2014–lung cancer is noted to be increasing in females as well.

Overall, the study demonstrated that the proportion of deaths attributed to any type of cancer is predicted to decline in Europe in 2014. However, pancreatic cancer is the only type of cancer in which increasing death rates are predicted for both men and women this year, as well as lung cancer in females.

“Our predictions for 2014 confirm that pancreatic death rates are continuing to increase overall,” said Dr. Carlo La Vecchia, lead author of the study.

Against a peak in rates of cancer observed in 1988, there has been an overall decrease of 26% in cancer deaths in men and 20% in women in the EU.

This translates to “over 250,000 cancer deaths avoided this year,” said La Vecchia.

However, as La Vecchia explains, “this year we predict that 41,300 men and 41,000 women will die from pancreatic cancer – an age standardized rate of 8.0 and 5.6 deaths respectively per 100,000 of the population.” “This represents a small but steady increase since the beginning of this century; between 2000-2004 death rates from the disease were 7.6 per 100,000 men and 5.0 per 100,000 women.”

“The increased death rate is cause for concern, because the prognosis for this tumour is bleak, with less than five percent of pancreatic cancer patients surviving for five years after diagnosis,” said La Vecchia.

“As so few patients survive, the increase in deaths is very closely related to the increase in incidence of this disease. This makes pancreatic cancer a priority for finding better ways to prevent and control it and better treatments,” added LaVecchia.

Established risk factors for pancreatic cancer include a family history of pancreatic cancer, smoking, obesity, diabetes and excessive alcohol intake.

“To date, we have no promising treatment for pancreatic cancer. Prevention remains, therefore, the only possibility, with smoking cessation first, plus control of overweight and diabetes. However, tobacco accounts for less than a third of all cases of pancreatic cancer, and all the other causes together account for another ten percent. More work needs to be done to discover other possible causes,” said La Vecchia.

Dr. Stephanie Bernik, Chief of Surgical Oncology at Lenox Hill Hospital in New York City agreed with the conclusions of the authors of the study.

“Most of the news from this report is favorable, as the rate of death from most cancers is dropping. It is unfortunate that the rate of death and the incidence of pancreatic cancer continues to rise. This is one of the types of cancers where we have failed to make progress in both prevention and cure.”

“As we learn more about the causes of cancer on the cellular level, the hope is that we will gain insight as to how to irradiate the disease, added Bernik.

The Annals study estimates that 742,500 men and 581,100 women will die from cancer in 2014 in the EU. While the actual absolute numbers have increased when compared with 2009 due to the increased numbers of elderly people, the rate (age-adjusted per 100,000 of the population) of people who die from the disease has dropped from 148.3 male and 89.1 female deaths per 100,000 in 2009 to 138.1 deaths and 84.7 per 100,000 estimated for 2014. As a result, there has been 7% decline among men and 5% decline among women, since 2009.

Investigators focused on pancreatic cancer due to its negative trends. In men, estimated rates for the three major cancers (lung, colorectal and prostate cancer) have fallen by 8%, 4% and 10% respectively since 2009. In women, breast and colorectal cancer death rates will fall by 9% and 7% respectively, but lung cancer death rates will rise by 8%.

“Deaths among men are 63% higher than in women, but they are falling faster, due mainly to the history of different smoking patterns in the two sexes. Lung cancer in men peaked in the late 1980s and has been falling since, while rates of lung cancer continue to rise in women,” offered La Vecchia.

“The generations of women who started smoking in the 1960s and 1970s are now starting to develop lung cancer. Lung cancer will become the first cause of death in European women in the next few years, overtaking breast cancer,” said La Vecchia.

The fall in colorectal cancer in both men and women is largely due to screening, early diagnosis and removal of adenomas at colonoscopy. Improved treatment has also had a role. For prostate cancer, the key reason for the fall in death rates is improved management and treatment, with a possible role played by screening and early diagnosis. For breast cancer, it is largely due to better management and treatment, but screening and early diagnosis have also had an impact.

Study co-author Fabio Levi (MD), Head of the Cancer Epidemiology Unit at the Institute of Social and Preventive Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, (Switzerland) offered the following explanation.

“Besides enforcing tobacco control – essentially by increasing taxation – national governments and EU policy makers must ensure that all EU citizens have access to the best screening, diagnosis and treatment, including those from central and eastern Europe where major delays are still observed and where cancer mortality rates tend to be higher as a result.”

Dr. Paolo Boffetta, the Annals of Oncology associate editor for epidemiology and Director of the Institute of Translational Epidemiology at the Icahn School of Medicine at Mount Sinai in New York (USA), offered his analysis : “These results are extremely important in showing that reducing cancer mortality can be achieved: priority should be given to research in cancers with unfavorable trends, such as pancreatic cancer, and in reducing cancer mortality disparities, both between countries (Central/Eastern versus Western Europe), and within countries, for example, between socioeconomic groups.”

Donald A. Richards, M.D., Ph.D., an oncologist with Texas Oncology-Tyler, a practice in The US Oncology Network acknowledges the trend toward increased rates of pancreatic cancer in Europe for 2014, but believes that “we may not be able to extrapolate the European data to the remainder of the world.”

“There are a number of factors that increase the risk for pancreatic cancer,” explained Richards, noting that “tobacco is one of the primary risk factors for pancreatic cancer.”

Richards goes on to state that “our current concept of the development of pancreatic cancer from the initiation of a malignant transformation to the time that it is diagnosed is around 20 years.” While he concedes that smoking trends have been decreasing, he feels we need to be looking at events that triggered the transformation 20 years ago. Richards adds that we have seen a “significant rise in obesity rates in Europe and North America, also giving an increased rate of pancreatic cancer,” while noting that the diagnosis of diabetes is associated with increased risk for pancreatic cancer as well.

In regards to other cancers such as colorectal cancer, Richards points out that they clearly have different risk factors.

“Family history certainly can play a role in the risk for pancreatic cancer; however, this is a small minority of those patients that will ultimately be affected by this disease.”

“The key point that clinicians need to be aware of is recognizing early signs of pancreatic cancer”, explains Richards. “Unfortunately, we do not have a screening test for pancreatic cancer like we do for colon cancer and prostate cancer, for example.”

“Pancreatic cancer is typically discovered in an advanced state and unfortunately, the mortality rate just about equals the rate of incidence of this disease,” added Richards.