Pancreatic cancer is one of the deadliest cancers with short-term survival rates. Trends for pancreatic cancer incidence and mortality varied considerably in the world. To date, the causes of pancreatic cancer are not known sufficiently, although certain risk factors have been identified such as, smoking, obesity, life style, diabetes mellitus, alcohol, dietary factors and chronic pancreatitis. Since there are no current screening recommendations for pancreatic cancer, primary prevention is very important. Therefore, up-to-date statistics on pancreatic cancer occurrence and outcome are essential for the primary prevention of this disease. Due to the lack of information on epidemiology of pancreatic cancer in most Asian countries, and limited of statistics and registration system in this area, we conducted a systematic review study to evaluate the most recent data concerning epidemiology of pancreatic cancer in Asia-Pacific region. In this review we focused on collected recent data on incidence, mortality, survival and risk factors of pancreatic cancer in this region. In addition, we reviewed and used the data of GLOBOCAN 2012 in this paper to complete the information as a source of compiling pancreatic cancer incidence and mortality rate.
Keywords: Pancreatic cancer, Epidemiology, Risk factors, Asia, Pacific.
Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. International journal of cancer 2015;136:E359-86.
Kleeff J, Korc M, Apte M, La Vecchia C, Johnson CD, Biankin AV, et al. Pancreatic cancer. Nat Rev Dis Primers 2016;2:16022.
Xiao AY, Tan ML, Wu LM, Asrani VM, Windsor JA, Yadav D, et al. Global incidence and mortality of pancreatic diseases: a systematic review, meta-analysis, and meta-regression of population-based cohort studies. Lancet Gastroenterol Hepatol 2016;1:45-55.
Ilic M, Ilic I. Epidemiology of pancreatic cancer. World journal of gastroenterology 2016;22:9694-705.
Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; 2013. Available from: http://globocan.iarc.fr, accessed on day/month/year.
Kongkam P, Benjasupattananun P, Taytawat P, Navicharoen P, Sriuranpong V, Vajragupta L, et al. Pancreatic cancer in an Asian population. Endoscopic Ultrasound 2015;4:56-62.
Pourhoseingholi MA, Vahedi M, Baghestani AR. Burden of gastrointestinal cancer in Asia; an overview. Gastroenterology and hepatology from bed to bench 2015;8:19-27.
Parr CL, Batty GD, Lam TH, Barzi F, Fang X, Ho SC, et al. Body-mass index and cancer mortality in the Asia-Pacific Cohort Studies Collaboration: pooled analyses of 424,519 participants. Lancet Oncol 2010;11:741-52.
Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; 2015. Available from: http://globocan.iarc.fr/Pages/online.aspx.
United Nations, Department of Economic and Social Affairs, Population Division (2013). World Population Prospects: The 2012 Revision, Highlights and Advance Tables. Working Paper No. ESA/P/WP.228. .
Statistical Yearbook for Asia and the Pacific 2014. United Nations PublicationCopyright. United Nations 2014 All rights reserved ST/ESCAP/2704.
Ansary-Moghaddam A, Huxley R, Barzi F, Lawes C, Ohkubo T, Fang X, et al. The effect of modifiable risk factors on pancreatic cancer mortality in populations of the Asia-Pacific region. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 2006;15:2435-40.
Taghavi A, Fazeli Z, Vahedi M, Baghestani AR, Zali MR, Pourhoseingholi MA. Pancreatic Cancer Mortality and Misclassification - Bayesian Analysis. Asian Pacific Journal of Cancer Prevention 2011;12:2271-4.
Hadizadeh M, Padashi M, Mohammad Alizadeh AH, Zali MR. Clinical, laboratory biomarkers and imaging findings of pancreatic adenocarcinoma in Iran. Asian Pacific journal of cancer prevention : APJCP 2014;15:4349-52.
Hassanzade J, Molavi EVH, Farahmand M, Rajaiifard AR. Incidence and Mortality Rate of Common Gastrointestinal Cancers in South of Iran, a Population Based Study. Iran J Cancer Prev 2011;4:163-9.
Cancer Facts and Figures; 2009. American cancer Society. Available at
Al-Majed HT, El-Basmi AA, Al-Mohannadi SH, Govindan R, Rajakumari GB. Pancreatic cancer: Incidence, clinical profile, and frequency of associated factors in Kuwait. Alexandria Journal of Medicine 2012;49:75-80.
Weber A, Kehl V, Mittermeyer T, Herberich E, Rothling N, Schmid RM, et al. Prognostic factors for survival in patients with unresectable pancreatic cancer. Pancreas 2010;39:1247-53.
AlGhamdi HJ, Alfaifi SA, Alolayan AA, Musaad SMA, Jazieh AM. Pancreatic cancer in Saudi patients treated at tertiary institution Ten years retrospective study. Saudi Medical Journal 2013;34:604-8.
Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin 2012;62:10-29.
Fesinmeyer MD, Austin MA, Li CI, De Roos AJ, Bowen DJ. Differences in survival by histologic type of pancreatic cancer. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 2005;14:1766-73.
Midha S, Chawla S, Garg PK. Modifiable and non-modifiable risk factors for pancreatic cancer: A review. Cancer Lett 2016;381:269-77.
Maisonneuve P, Lowenfels AB. Risk factors for pancreatic cancer: a summary review of meta-analytical studies. Int J Epidemiol 2015;44:186-98.
Kuzmickiene I, Everatt R, Virviciute D, Tamosiunas A, Radisauskas R, Reklaitiene R, et al. Smoking and other risk factors for pancreatic cancer: A cohort study in men in Lithuania. Cancer Epidemiology 2013;37:133-9.
Mizuno S, Nakai Y, Isayama H, Kawahata S, Saito T, Takagi K, et al. Smoking, Family History of Cancer, and Diabetes Mellitus Are Associated With the Age of Onset of Pancreatic Cancer in Japanese Patients. Pancreas 2014;43:1014-7.
Pelucchi C, Galeone C, Polesel J, Manzari M, Zucchetto A, Talamini R, et al. Smoking and Body Mass Index and Survival in Pancreatic Cancer Patients. Pancreas 2014;43:47-52.
Matsuo K, Ito H, Wakai K, Nagata C, Mizoue T, Tanaka K, et al. Cigarette smoking and pancreas cancer risk: an evaluation based on a systematic review of epidemiologic evidence in the Japanese population. Jpn J Clin Oncol 2011;41:1292-302.
Lynch SM, Vrieling A, Lubin JH, Kraft P, Mendelsohn JB, Hartge P, et al. Cigarette smoking and pancreatic cancer: a pooled analysis from the pancreatic cancer cohort consortium. American journal of epidemiology 2009;170:403-13.
Katanoda K, Marugame T, Saika K, Satoh H, Tajima K, Suzuki T, et al. Population attributable fraction of mortality associated with tobacco smoking in Japan: a pooled analysis of three large-scale cohort studies. J Epidemiol 2008;18:251-64.
Tan D. Smoking In Asia: A Looming Health Epidemic, Read more from Asian Scientist Magazine at: http://www.asianscientist.com/2012/08/features/smoking-in-asia-looming-health-epidemic-2012/George Asian Scientist Magazine 2012.
World Health Organization, Global Status Report on Noncommunicable Diseases 2010 (Geneva, WHO, 2010).
Davoodi SH, Malek-Shahabi T, Malekshahi-Moghadam A, Shahbazi R, Esmaeili S. Obesity as an important risk factor for certain types of cancer. Iran J Cancer Prev 2013;6:186-94.
Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med 2003;348:1625-38.
Berrington de Gonzalez A, Sweetland S, Spencer E. A meta-analysis of obesity and the risk of pancreatic cancer. Br J Cancer 2003;89:519-23.
Li D, Morris JS, Liu J, Hassan MM, Day RS, Bondy ML, et al. Body mass index and risk, age of onset, and survival in patients with pancreatic cancer. Jama 2009;301:2553-62.
Arslan AA, Helzlsouer KJ, Kooperberg C, Shu XO, Steplowski E, Bueno-de-Mesquita HB, et al. Anthropometric measures, body mass index, and pancreatic cancer: a pooled analysis from the Pancreatic Cancer Cohort Consortium (PanScan). Arch Intern Med 2010;170:791-802.
Asia Pacific Cohort Studies Collaboration. The burden of overweight and obesity in the Asia-Pacific region. Obes Rev 2007;8:191-6.
Wang YT, Gou YW, Jin WW, Xiao M, Fang HY. Association between alcohol intake and the risk of pancreatic cancer: a dose-response meta-analysis of cohort studies. BMC Cancer 2016;16:212.
Lucenteforte E, La Vecchia C, Silverman D, Petersen GM, Bracci PM, Ji BT, et al. Alcohol consumption and pancreatic cancer: a pooled analysis in the International Pancreatic Cancer Case-Control Consortium (PanC4). Ann Oncol 2012;23:374-82.
Tramacere I, Scotti L, Jenab M, Bagnardi V, Bellocco R, Rota M, et al. Alcohol drinking and pancreatic cancer risk: a meta-analysis of the dose-risk relation. International journal of cancer 2010;126:1474-86.
OECD (2014), "Alcohol", in OECD/WHO, Health at a Glance: Asia/Pacific 2014: Measuring Progress towards Universal Health Coverage, OECD Publishing, Paris.
Rahman F, Cotterchio M, Cleary SP, Gallinger S. Association between Alcohol Consumption and Pancreatic Cancer Risk: A Case-Control Study. Plos One 2015;10.
Michaud DS, Skinner HG, Wu K, Hu F, Giovannucci E, Willett WC, et al. Dietary patterns and pancreatic cancer risk in men and women. Journal of the National Cancer Institute 2005;97:518-24.
Lightsey D NCAHFaQ. Comment on “Red and processed meat consumption and risk of pancreatic cancer: meta-analysis of prospective studies.” British Journal of Cancer 2012;107:754-5.
Stolzenberg-Solomon RZ, Cross AJ, Silverman DT, Schairer C, Thompson FE, Kipnis V, et al. Meat and meat-mutagen intake and pancreatic cancer risk in the NIH-AARP cohort. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 2007;16:2664-75.
Beaney AJ, Banim PJR, Luben R, Lentjes MAH, Khaw KT, Hart AR. Higher Meat Intake Is Positively Associated With Higher Risk of Developing Pancreatic Cancer in an Age-Dependent Manner and Are Modified by Plasma Antioxidants: A Prospective Cohort Study (EPIC-Norfolk) Using Data From Food Diaries. Pancreas 2017;46:672-8.
Paluszkiewicz P, Smolinska K, Debinska I, Turski WA. Main dietary compounds and pancreatic cancer risk. The quantitative analysis of case-control and cohort studies. Cancer Epidemiol 2012;36:60-7.
Larsson SC, Wolk A. Red and processed meat consumption and risk of pancreatic cancer: meta-analysis of prospective studies. Br J Cancer 2012;106:603-7.
Miller PE, Alexander D. A Review and Meta-Analysis of Prospective Studies of Red and Processed Meat and Pancreatic Cancer. The FASEB Journal 2016;30:902-9.
Aschebrook-Kilfoy B, Cross AJ, Stolzenberg-Solomon RZ, Schatzkin A, Hollenbeck AR, Sinha R, et al. Pancreatic cancer and exposure to dietary nitrate and nitrite in the NIH-AARP Diet and Health Study. American journal of epidemiology 2011;174:305-15.
Yadav D, Lowenfels AB. The epidemiology of pancreatitis and pancreatic cancer. Gastroenterology 2013;144:1252-61.
Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, et al. SEER Cancer Statistics Review, 1975-2012, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2012/, based on November 2014 SEER data submission, posted to the SEER web site, April 2015. 2015.
Brotherton L, Welton M, Robb SW. Racial disparities of pancreatic cancer in Georgia: a county-wide comparison of incidence and mortality across the state, 2000-2011. Cancer medicine 2016;5:100-10.
Shavers VL, Harlan LC, Jackson M, Robinson J. Racial/ethnic patterns of care for pancreatic cancer. Journal of palliative medicine 2009;12:623-30.
Ma J, Siegel R, Jemal A. Pancreatic cancer death rates by race among US men and women, 1970-2009. Journal of the National Cancer Institute 2013;105:1694-700.
American Cancer Society, Cancer Facts and figures 2014, American Cancer Society, Atlanta. 2014.
Arnold LD, Patel AV, Yan Y, Jacobs EJ, Thun MJ, Calle EE, et al. Are racial disparities in pancreatic cancer explained by smoking and overweight/obesity? Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 2009;18:2397-405.
Pernick NL, Sarkar FH, Philip PA, Arlauskas P, Shields AF, Vaitkevicius VK, et al. Clinicopathologic analysis of pancreatic adenocarcinoma in African Americans and Caucasians. Pancreas 2003;26:28-32.
Dong M, Nio Y, Tamura K, Song MM, Guo KJ, Guo RX, et al. Ki-ras point mutation and p53 expression in human pancreatic cancer: a comparative study among Chinese, Japanese, and Western patients. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 2000;9:279-84.
Song MM, Nio Y, Dong M, Tamura K, Furuse K, Tian YL, et al. Comparison of K-ras point mutations at codon 12 and p21 expression in pancreatic cancer between Japanese and Chinese patients. Journal of surgical oncology 2000;75:176-85.
Longnecker DS, Karagas MR, Tosteson TD, Mott LA. Racial differences in pancreatic cancer: comparison of survival and histologic types of pancreatic carcinoma in Asians, blacks, and whites in the United States. Pancreas 2000;21:338-43.
Permuth-Wey J, Egan KM. Family history is a significant risk factor for pancreatic cancer: results from a systematic review and meta-analysis. Familial cancer 2009;8:109-17.
Shi C, Hruban RH, Klein AP. Familial pancreatic cancer. Arch Pathol Lab Med 2009;133:365-74.
Jacobs EJ, Chanock SJ, Fuchs CS, Lacroix A, McWilliams RR, Steplowski E, et al. Family history of cancer and risk of pancreatic cancer: a pooled analysis from the Pancreatic Cancer Cohort Consortium (PanScan). International journal of cancer 2010;127:1421-8.
Ghiorzo P. Genetic predisposition to pancreatic cancer. World journal of gastroenterology 2014;20:10778-89.
Shi C, Daniels JA, Hruban RH. Molecular characterization of pancreatic neoplasms. Adv Anat Pathol 2008;15:185-95.
Solomon S, Das S, Brand R, Whitcomb DC. Inherited pancreatic cancer syndromes. Cancer journal (Sudbury, Mass) 2012;18:485-91.
Greer JB, Whitcomb DC, Brand RE. Genetic predisposition to pancreatic cancer: a brief review. The American journal of gastroenterology 2007;102:2564-9.
Klein AP. Genetic susceptibility to pancreatic cancer. Molecular carcinogenesis 2012;51:14-24.
Toki M, Yamaguchi Y, Kurata I, Tabei K, Hata H, Hasue T, et al. Diabetes Mellitus As a Risk Factor for Pancreatic Cancer-for Realization of Efficient Screening of Pancreatic Cancer in Patients With Diabetes Mellitus. Gastroenterology 2013;144:S659-S.
McAuliffe JC, Christein JD. Type 2 Diabetes Mellitus and Pancreatic Cancer. Surgical Clinics of North America 2013;93:619-+.
Li D, Tang H, Hassan MM, Holly EA, Bracci PM, Silverman DT. Diabetes and risk of pancreatic cancer: a pooled analysis of three large case-control studies. Cancer causes & control : CCC 2011;22:189-97.
Liao KF, Lai SW, Li CI, Chen WC. Diabetes mellitus correlates with increased risk of pancreatic cancer: A population-based cohort study in Taiwan. Journal of Gastroenterology and Hepatology 2012;27:709-13.
International Diabetes Federation. IDF Diabetes Atlas,6 th edn. Brussles, Belgium: International Diabetes Federation, 2013.
Raimondi S, Lowenfels AB, Morselli-Labate AM, Maisonneuve P, Pezzilli R. Pancreatic cancer in chronic pancreatitis; aetiology, incidence, and early detection. Best Pract Res Clin Gastroenterol 2010;24:349-58.
Duell EJ, Lucenteforte E, Olson SH, Bracci PM, Li D, Risch HA, et al. Pancreatitis and pancreatic cancer risk: a pooled analysis in the International Pancreatic Cancer Case-Control Consortium (PanC4). Ann Oncol 2012;23:2964-70.
Yadav D, Whitcomb DC. The role of alcohol and smoking in pancreatitis. Nature reviews Gastroenterology & hepatology 2010;7:131-45.
Hirota M, Shimosegawa T, Masamune A, Kikuta K, Kume K, Hamada S, et al. The sixth nationwide epidemiological survey of chronic pancreatitis in Japan. Pancreatology : official journal of the International Association of Pancreatology (IAP) [et al] 2012;12:79-84.
Garg PK, Tandon RK. Survey on chronic pancreatitis in the Asia-Pacific region. J Gastroenterol Hepatol 2004;19:998-1004.
Mohan V, Farooq S, Deepa M. Prevalence of fibrocalculous pancreatic diabetes in Chennai in South India. JOP : Journal of the pancreas 2008;9:489-92.
Midha S, Sreenivas V, Kabra M, Chattopadhyay TK, Joshi YK, Garg PK. Genetically Determined Chronic Pancreatitis but not Alcoholic Pancreatitis Is a Strong Risk Factor for Pancreatic Cancer. Pancreas 2016;45:1478-84.
Global Status Report on Alcohol and Health. 2011 http://www.who.int/substance_abuse/publications/global_alcohol_report/en/index.html.
Trikudanathan G, Philip A, Dasanu CA, Baker WL. Association between Helicobacter pylori infection and pancreatic cancer. A cumulative meta-analysis. JOP : Journal of the pancreas 2011;12:26-31.
Ben Q, Li Z, Liu C, Cai Q, Yuan Y, Wang K, et al. Hepatitis B virus status and risk of pancreatic ductal adenocarcinoma: a case-control study from China. Pancreas 2012;41:435-40.
Ashtari S, Pourhoseingholi MA, Sharifian A, Zali MR. Hepatocellular carcinoma in Asia: Prevention strategy and planning. World journal of hepatology 2015;7:1708-17.
Alter MJ. Epidemiology of hepatitis C virus infection. World journal of gastroenterology 2007;13:2436-41.
Ashtari S, Pourhoseingholi MA, Molaei M, Taslimi H, Zali MR. The prevalence of Helicobacter pylori is decreasing in Iranian patients. Gastroenterology and hepatology from bed to bench 2015;8:S23-9.
Risch HA, Yu H, Lu L, Kidd MS. ABO blood group, Helicobacter pylori seropositivity, and risk of pancreatic cancer: a case-control study. Journal of the National Cancer Institute 2010;102:502-5.
Franchini M, Liumbruno GM, Lippi G. The prognostic value of ABO blood group in cancer patients. Blood transfusion = Trasfusione del sangue 2016;14:434-40.
Zhang BL, He N, Huang YB, Song FJ, Chen KX. ABO blood groups and risk of cancer: a systematic review and meta-analysis. Asian Pacific journal of cancer prevention : APJCP 2014;15:4643-50.
Risch HA, Lu L, Wang J, Zhang W, Ni Q, Gao YT, et al. ABO blood group and risk of pancreatic cancer: a study in Shanghai and meta-analysis. American journal of epidemiology 2013;177:1326-37.
Wolpin BM, Kraft P, Gross M, Helzlsouer K, Bueno-de-Mesquita HB, Steplowski E, et al. Pancreatic cancer risk and ABO blood group alleles: results from the pancreatic cancer cohort consortium. Cancer research 2010;70:1015-23.