Pancreatic cancer cases rise among younger women, especially those aged 15 to 34 years
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Pancreatic cancer incidence increased among both men and women from 2000 to 2018, but researchers reported a greater relative increase among women aged younger than 55 years, according to study results published in JAMA.
The most dramatic increase occurred among women aged 15 to 34 years, researchers wrote.
Further investigations will be needed to validate the findings and identify potential causes of the higher rates among younger women, according to Srinivas Gaddam, MD, MPH, assistant professor of medicine and interventional gastroenterology in the Karsh division of gastroenterology and hepatology at Cedars-Sinai.
“I’m an interventional gastroenterologist and as part of clinical responsibilities, I perform endoscopic ultrasound to diagnose pancreatic cancer in this patient group,” Gaddam told Healio. “Recently, I saw young women receive this diagnosis. I wasn’t sure if what I was seeing was just biased observation vs. a true trend.
“Quite a few of the observations that physicians make can be biased because we do not get to see the whole spectrum of disease,” he added. “The only way to answer this question definitively was to evaluate this in a large national database.”
Gaddam and colleagues used the SEER database, which covers about 37% of the U.S. population, to perform an sex- and age-specific time-trend analysis that would reveal trends and changes in pancreatic cancer incidence over time.
The analysis included 283,817 reported pancreatic cases (50.1% women, 11.4% aged younger than 55 years) from 2000 to 2018. Investigators assessed incidence rates per 100,000 population and calculated annual percentage change, as well as average annual percentage change (AAPC). They defined individuals aged younger than 55 years as younger adults and individuals aged 55 years or older as older adults.
Results showed the AAPC of all pancreatic cancer cases significantly increased among both women (0.78%; 95% CI, 0.68-0.88) and men (0.9%; 95% CI, 0.82-0.99), with no statistically significant difference between the sexes (difference, 0.12%; 95% CI, 0-0.25).
However, analyses stratified by age group showed significant variation in trends.
The AAPCs among older adults suggested a larger increase among men vs. women (0.92% vs. 0.62%). However, the AAPC among those aged younger than 55 years revealed a significantly larger relative increase among women (1.93%; 95% CI, 1.57-2.28) compared with men (0.77%; 95% CI, 0.5-1.05).
Among individuals aged 15 to 34 years (n = 1,538; 58.2% women), the AAPC was 7.68% (95% CI, 6.21-9.18) for women vs. 4.2% (95% CI, 2.54-5.9) for men.
Gaddam told Healio the latter “steeper rise” in younger women was surprising, but that the data should be interpreted with caution.
“The risk for cancer in this age group is still very low — less than 1 per 100,000,” Gaddam said. “In addition, this group only accounts for 0.5% of all pancreatic cancer cases.”
Gaddam called for additional investigation of the disproportionate increase in incidence among young women.
“Does it have something to do with environment exposure vs. medication vs. other risk factors to which women are at disproportionately higher risk for exposure? These risk factors, if identified, can offer greater insight into the pathogenesis of this cancer,” he said.
Additionally, Gaddam said he would like to see continued research to validate the data in larger, national cohorts.
For more information:
Srinivas Gaddam, MD, MPH, can be reached at Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, 8700 Beverly Blvd., South Tower, Suite 7705, Los Angeles, CA 90048; email: srinivas.gaddam@cshs.org.
Perspective
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Sanjay S. Reddy, MD, FACS
This article brings attention to an important fact about pancreatic cancer — not only that as a community we are much more aware of this disease, but also that there may, indeed, be a sex-based disproportional exposure to known or unknown risk factors.
Among those aged 55 years or older, the annual percentage change and AAPC in incidence increased among both men and women. Perhaps this is directly related to being more vigilant about our health in general. Among those aged younger than 55 years, the increase was greater for women than men. This is a worrisome trend, as it brings attention to possible risk factors that may be avoidable and/or contribute in some part to the development of pancreatic cancer.
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