The Rise and Fall of Cancer Mortality in the USA: Why Does Pancreatic Cancer Not Follow the Trend?
2013; Future Medicine; Volume: 9; Issue: 7 Linguagem: Inglês
10.2217/fon.13.76
ISSN1744-8301
Autores Tópico(s)Cancer Genomics and Diagnostics
ResumoFuture OncologyVol. 9, No. 7 EditorialFree AccessThe rise and fall of cancer mortality in the USA: why does pancreatic cancer not follow the trend?Jiemin Ma & Ahmedin JemalJiemin Ma* Author for correspondenceSurveillance & Health Services Research Program, American Cancer Society, 250 Williams Street, Atlanta, GA 30303, USA. . & Ahmedin JemalSurveillance & Health Services Research Program, American Cancer Society, 250 Williams Street, Atlanta, GA 30303, USAPublished Online:3 Jul 2013https://doi.org/10.2217/fon.13.76AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinkedInReddit Keywords: mortalitypancreatic cancerscreeningsmokingsurvivalAfter decades of increase, death rates from all cancers combined have been decreasing since the early 1990s among both men and women in the USA [1]. This trend largely reflects the evolution of death rates from the four major cancer sites, in other words, lung, colorectum, female breast and prostate. By contrast, the fourth-leading cause of cancer death in the USA – pancreatic cancer – has not been following the general cancer mortality trend over the years. Specifically, pancreatic cancer death rates have been increasing in both sexes since the early 2000s, after a three-decade decrease in men and a two-decade stable period in women [1]. Reasons for this trend discrepancy between all cancer and pancreatic cancer mortality can be found in all segments of the cancer continuum, from etiology and primary prevention through early detection and screening to treatment and survival.Etiology & primary preventionCigarette smoking has been a major driver of cancer mortality trends in the USA. Largely driven by lung cancer death rates, the rise and fall of all cancer mortality greatly mirrors the trends in smoking prevalence with a lag period of approximately 20–30 years, although early detection and/or treatment have played a major role in rate reduction for some specific cancer sites. Since its peak in the mid-1960s, adult smoking prevalence in the USA has continued to decrease over the last half century [2,3].Correspondingly, all cancer mortality among men increased until 1990 and then decreased thereafter, coinciding with lung cancer mortality trends [1]. By contrast, among women, lung cancer death rates did not decrease until the early 2000s because of their later uptake of smoking epidemic [1,4]. Therefore, the decrease in all cancer mortality among women beginning in 1991 has been thought to be a combined result of a concurrent decrease in breast, colorectal and lung (younger than 65 years only) cancer death rates [5].Pancreatic cancer is also a smoking-related disease; approximately 20% of pancreatic cancer deaths in the USA are attributable to cigarette smoking [6]. Unsurprisingly, it has been widely accepted that smoking was the main contributor to the increases in pancreatic cancer death rates from the 1930s to the early 1970s in men and from the 1930s to the mid-1980s in women, as well as the following decrease in men and leveling off in women until the early 2000s [5]. However, the reasons why the decrease and level off of pancreatic cancer death rates occurred 20 years earlier than that of lung cancer death rates remain largely unexplained. One possible reason is that smoking may serve as a late-stage carcinogen in pancreatic cancer occurrence. This is supported by a recent pooled analysis that found a quick reduction in pancreatic cancer risk after smoking cessation [7]. Alternatively, other risk factors may have modified the effects of smoking on pancreatic cancer trends over the years. Although this explanation remains to be tested, it is quite clear that recent changes in certain risk factors have offset the impacts of decreased smoking prevalence in the USA, as pancreatic cancer death rates have been increasing in both men and women since the early 2000s.Of the possible contributors to the recent increases in pancreatic cancer deaths, obesity is clearly at the top of the list. Obesity has been reported to be associated with an approximate 20% increase in pancreatic cancer risk, compared with normal weight [8]. Over the past three decades, adult obesity prevalence in the USA has increased by approximately 3.5-fold, from 10% in 1976–1980 to 36% in 2009–2010 [9,10]. Owing to the possible long latency period between obesity and pancreatic cancer death, the consequences of fairly recent increases in obesity prevalence may have not fully manifested; the obesity epidemic is highly likely to lead to further increases in pancreatic cancer death rates. As the associations between pancreatic cancer and other lifestyle risk factors, such as physical inactivity and low intake of fruit and vegetables, are still unclear, the extent to which these factors have contributed to the recent increases in pancreatic death rates remains to be determined. It is also unclear whether recent advances in imaging techniques have artificially increased pancreatic cancer death rates in the USA, as reported in some European countries [11].Early detection & screeningColorectal cancer screening was introduced in the early 1980s in the USA. By 2010, approximately 59% of USA adults aged 50–75 years were up to date with their colorectal cancer screening according to US Preventive Services Task Force guidelines [12]. The widespread use of colorectal cancer screening has contributed substantially to the reductions in colorectal cancer mortality, as well as in colorectal cancer incidence through detection and removal of precancerous polyps [4]. By contrast, the benefits from mammography are concentrated on mortality reduction through detecting early-stage breast cancers. It has been estimated that mammography accounted for half of the reduction in breast cancer mortality in the USA [13]. In 2010, approximately 72% of women aged 50–74 years in the USA reported having had mammography during the past 2 years. Likewise, the use of the PSA test may have contributed to the substantial decreases in prostate cancer death rates since the early 1990s. However, there have been mixed results regarding the benefit of PSA testing in reducing prostate cancer mortality in recent clinical trials [14,15]. With regard to cervical cancer, the contribution of the Pap smear test to the reduction in incidence and mortality has been widely documented as a great achievement in cancer control and prevention [4].By contrast, so far there has been no such early detection method with sufficient sensitivity and specificity to serve as a tool for pancreatic cancer screening. In addition, the feasibility of pancreatic cancer screening among the general population is largely questionable, owing to the relatively low incidence rates. Thus, existing research programs on screening have been restricted to high-risk individuals, such as those with chronic pancreatitis, Peutz–Jeghers syndrome or familial atypical multiple mole melanoma syndrome [16]. Results from these studies showed that single use of endoscopic ultrasound or various combinations of imaging techniques are capable of detecting early pancreatic cancer or precancerous lesions among these high-risk populations [16]. However, it remains unclear whether screening by this method is effective in reducing pancreatic cancer mortality. Recent advances in understanding the molecular basis of pancreatic cancer may offer some promise for the discovery of new methods for the early detection of pancreatic cancer [17].Treatment & survivalOwing to the improvements in treatment of most cancers, the 5-year relative survival rate for all cancers combined has increased from 49 to 67% over the past 30 years [101]. By contrast, there have been no significant advances in developing effective treatment for pancreatic cancer. At present, the 5-year relative survival rate for pancreatic cancer is still only approximately 6%, and most patients will die within 1 year of diagnosis [101]. One reason for this low survival rate is that most pancreatic cancers are diagnosed at a late stage, when the tumor has spread to surrounding tissues or distant organs. In the USA, only approximately 15–20% of pancreatic cancer cases are diagnosed early enough to be eligible for surgery – by far the only treatment that offers a chance of cure for pancreatic cancer patients. Even for patients with a tumor that has been surgically removed, the 5-year survival rate is only approximately 20–25%. Treatment for patients with advanced disease still remains largely palliative. In recent years, researchers have discovered some promising molecular biomarkers for prognosis prediction; however, their prognostic and predictive values remain to be further validated [18].ConclusionIn stark contrast to the decreasing rates for all cancers combined and other major cancer sites, pancreatic cancer death rates have been increasing since the early 2000s owing to the lack of progress in pancreatic cancer-specific primary prevention, early detection and treatment, as well as increases in risk factors such as obesity. In 2013, approximately 38,460 Americans will die of pancreatic cancer [19]. With the full manifestation of the consequences of obesity epidemic, this toll will continue to increase for many years if no urgent interventions are to take effect. Tobacco control and maintaining healthy body weight are the only two known intervention strategies. A better understanding of the etiology of pancreatic cancer is warranted in order to formulate more effective intervention measures. Researchers have recently found some promising biomarkers with potential applications in early detection and personalized treatment. To substantially improve pancreatic cancer treatment and survival, however, concerted efforts from basic-science researchers, pharmaceutical scientists and physicians are urgently needed.Financial & competing interests disclosureThe authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.No writing assistance was utilized in the production of this manuscript.References1 Jemal A, Simard EP, Dorell C et al. Annual report to the nation on the status of cancer, 1975–2009, featuring the burden and trends in human papillomavirus (HPV)-associated cancers and HPV vaccination coverage levels. J. Natl. Cancer Inst.105(3),175–201 (2013).Crossref, Medline, Google Scholar2 Garrett BE, Dube SR, Trosclair A, Caraballo RS, Pechacek TF. Cigarette smoking – United States, 1965–2008. MMWR Surveill. Summ.60(Suppl.),109–113 (2011).Medline, Google Scholar3 Giovino GA, Schooley MW, Zhu BP et al. Surveillance for selected tobacco-use behaviors – United States, 1900–1994. MMWR Surveill. Summ.43(3),1–43 (1994).CAS, Google Scholar4 Jemal A, Ward E, Thun M. Declining death rates reflect progress against cancer. PLoS ONE5(3),e9584 (2010).Crossref, Medline, Google Scholar5 Wingo PA, Cardinez CJ, Landis SH et al. Long-term trends in cancer mortality in the United States, 1930–1998. Cancer97(12 Suppl.),3133–3275 (2003).Crossref, Medline, Google Scholar6 Iodice S, Gandini S, Maisonneuve P, Lowenfels AB. Tobacco and the risk of pancreatic cancer: a review and meta-analysis. Langenbecks Arch. Surg.393(4),535–545 (2008).Crossref, Medline, Google Scholar7 Lynch SM, Vrieling A, Lubin JH et al. Cigarette smoking and pancreatic cancer: a pooled analysis from the pancreatic cancer cohort consortium. Am. J. Epidemiol.170(4),403–413 (2009).Crossref, Medline, Google Scholar8 Arslan AA, Helzlsouer KJ, Kooperberg C et al. Anthropometric measures, body mass index, and pancreatic cancer: a pooled analysis from the Pancreatic Cancer Cohort Consortium (PanScan). Arch. Intern. Med.170(9),791–802 (2010).Crossref, Medline, Google Scholar9 Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. JAMA307(5),491–497 (2012).Crossref, Medline, Google Scholar10 Flegal KM, Carroll MD, Kuczmarski RJ, Johnson CL. Overweight and obesity in the United States: prevalence and trends, 1960–1994. Int. J. Obes. Relat. Metab. Disord.22(1),39–47 (1998).Crossref, Medline, CAS, Google Scholar11 Bosetti C, Bertuccio P, Negri E, La Vecchia C, Zeegers MP, Boffetta P. Pancreatic cancer: overview of descriptive epidemiology. Mol. Carcinog.51(1),3–13 (2012).Crossref, Medline, CAS, Google Scholar12 CDC. Cancer screening – United States, 2010. MMWR Morb. Mortal. Wkly Rep.61(3),41–45 (2012).Medline, Google Scholar13 Berry DA, Cronin KA, Plevritis SK et al. Effect of screening and adjuvant therapy on mortality from breast cancer. N. Engl. J. Med.353(17),1784–1792 (2005).Crossref, Medline, CAS, Google Scholar14 Schroder FH, Hugosson J, Roobol MJ et al. Screening and prostate-cancer mortality in a randomized European study. N. Engl. J. Med.360(13),1320–1328 (2009).Crossref, Medline, Google Scholar15 Andriole GL, Crawford ED, Grubb RL 3rd et al. Mortality results from a randomized prostate-cancer screening trial. N. Engl. J. Med.360(13),1310–1319 (2009).Crossref, Medline, CAS, Google Scholar16 Shin EJ, Canto MI. Pancreatic cancer screening. Gastroenterol. Clin. North Am.41(1),143–157 (2012).Crossref, Medline, Google Scholar17 Gemmel C, Eickhoff A, Helmstadter L, Riemann JF. Pancreatic cancer screening: state of the art. Expert Rev. Gastroenterol Hepatol.3(1),89–96 (2009).Crossref, Medline, CAS, Google Scholar18 Ansari D, Rosendahl A, Elebro J, Andersson R. Systematic review of immunohistochemical biomarkers to identify prognostic subgroups of patients with pancreatic cancer. Br. J. Surg.98(8),1041–1055 (2011).Crossref, Medline, CAS, Google Scholar19 Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA Cancer J. Clin.63(1),11–30 (2013).Crossref, Medline, Google Scholar101 Howlader N, Noone AM, Krapcho M et al. SEER cancer statistics review, 1975–2009 (vintage 2009 populations). http://seer.cancer.gov/csr/1975_2009_pops09/sections.htmlGoogle ScholarFiguresReferencesRelatedDetailsCited ByRacial and Gender Disparities Among Obese Patients With Pancreatic Cancer1 April 2023 | Journal of Clinical Gastroenterology, Vol. 57, No. 4Annual report to the nation on the status of cancer, part 1: National cancer statistics27 October 2022 | Cancer, Vol. 128, No. 24Emerging kinase inhibitors for the treatment of pancreatic ductal adenocarcinoma3 November 2022 | Expert Opinion on Emerging Drugs, Vol. 112T Cell–Mediated Antitumor Immunity Cooperatively Induced By TGFβR1 Antagonism and Gemcitabine Counteracts Reformation of the Stromal Barrier in Pancreatic Cancer10 August 2021 | Molecular Cancer Therapeutics, Vol. 20, No. 10Serum miRNA Profiling for Early PDAC Diagnosis and Prognosis: A Retrospective Study20 July 2021 | Biomedicines, Vol. 9, No. 7Place of Death among Cancer Patients in Brunei: A Retrospective Study1 July 2021 | Journal of Research Development in Nursing and Midwifery, Vol. 18, No. 2PALLD mutation in a European family conveys a stromal predisposition for familial pancreatic cancer25 March 2021 | JCI Insight, Vol. 6, No. 8Safety assessment of metarrestin in dogs: A clinical candidate targeting a subnuclear structure unique to metastatic cancer cellsRegulatory Toxicology and Pharmacology, Vol. 116Metabolism and pharmacokinetics characterization of metarrestin in multiple species17 March 2020 | Cancer Chemotherapy and Pharmacology, Vol. 85, No. 4The Association Between Body Mass Index and Pancreatic Cancer: Variation by Age at Body Mass Index Assessment11 October 2019 | American Journal of Epidemiology, Vol. 189, No. 2Next generation sequencing and functional pathway analysis to understand the mechanism of action of copper-tolfenamic acid against pancreatic cancer cellsProcess Biochemistry, Vol. 89Upcoming Revolutionary Paths in Preclinical Modeling of Pancreatic Adenocarcinoma22 January 2020 | Frontiers in Oncology, Vol. 9Organoïdes dérivés des adénocarcinomes pancréatiques4 February 2020 | médecine/sciences, Vol. 36, No. 1Spatial distribution and clusters of pancreatic cancer mortality in Shandong Province, China9 September 2019 | Scientific Reports, Vol. 9, No. 1Target Deconvolution of a Multikinase Inhibitor with Antimetastatic Properties Identifies TAOK3 as a Key Contributor to a Cancer Stem Cell–Like Phenotype1 November 2019 | Molecular Cancer Therapeutics, Vol. 18, No. 11High Expression of Long Noncoding RNA HOTAIRM1 is Associated with the Proliferation and Migration in Pancreatic Ductal Adenocarcinoma6 January 2019 | Pathology & Oncology Research, Vol. 25, No. 4Dual Farnesyl and Geranylgeranyl Transferase Inhibitor Thwarts Mutant KRAS-Driven Patient-Derived Pancreatic Tumors1 October 2019 | Clinical Cancer Research, Vol. 25, No. 19Combining Hyperpolarized Real-Time Metabolic Imaging and NMR Spectroscopy To Identify Metabolic Biomarkers in Pancreatic Cancer23 May 2019 | Journal of Proteome Research, Vol. 18, No. 7Comparison of endoscopic ultrasound tissue acquisition methods for genomic analysis of pancreatic cancer10 December 2018 | Journal of Gastroenterology and Hepatology, Vol. 34, No. 5Mechanisms Underlying Metastatic Pancreatic Cancer2 October 2019Overexpression of folate receptor alpha is an independent prognostic factor for outcomes of pancreatic cancer patients20 June 2018 | Medical Molecular Morphology, Vol. 51, No. 4Loss of PDPK1 abrogates resistance to gemcitabine in label-retaining pancreatic cancer cells31 July 2018 | BMC Cancer, Vol. 18, No. 1Loss of Linc01060 induces pancreatic cancer progression through vinculin-mediated focal adhesion turnoverCancer Letters, Vol. 433The role of long non-coding RNA AFAP1-AS1 in human malignant tumorsPathology - Research and Practice, Vol. 214, No. 10Evaluation of the 8th AJCC staging system for pathologically versus clinically staged pancreatic adenocarcinoma: A time to revisit a dogma?Hepatobiliary & Pancreatic Diseases International, Vol. 17, No. 1Pancreas 3D Organoids: Current and Future Aspects as a Research Platform for Personalized Medicine in Pancreatic CancerCellular and Molecular Gastroenterology and Hepatology, Vol. 5, No. 3Pancreatic Cancer Screening6 September 2017 | Current Treatment Options in Gastroenterology, Vol. 15, No. 4Prognostic value of site-specific metastases in pancreatic adenocarcinoma: A Surveillance Epidemiology and End Results database analysisWorld Journal of Gastroenterology, Vol. 23, No. 10 PET/MRI in pancreatic and periampullary cancer: correlating diffusion-weighted imaging, MR spectroscopy and glucose metabolic activity with clinical stage and prognosis19 March 2016 | European Journal of Nuclear Medicine and Molecular Imaging, Vol. 43, No. 10Blood expression of matrix metalloproteinases 8 and 9 and of their inducers S100A8 and S100A9 supports diagnosis and prognosis of PDAC-associated diabetes mellitusClinica Chimica Acta, Vol. 456Histone deacetylase (HDAC)-1, −2, −4 and −6 expression in human pancreatic adenocarcinoma: associations with clinicopathological parameters, tumor proliferative capacity and patients' survival26 October 2015 | BMC Gastroenterology, Vol. 15, No. 1High expression of AFAP1-AS1 is associated with poor survival and short-term recurrence in pancreatic ductal adenocarcinoma30 April 2015 | Journal of Translational Medicine, Vol. 13, No. 1Central adiposity, obesity during early adulthood, and pancreatic cancer mortality in a pooled analysis of cohort studiesAnnals of Oncology, Vol. 26, No. 11Roles of EGFR and KRAS and their downstream signaling pathways in pancreatic cancer and pancreatic cancer stem cellsAdvances in Biological Regulation, Vol. 59Metabolic Imaging of Pancreatic Ductal Adenocarcinoma Detects Altered Choline Metabolism14 January 2015 | Clinical Cancer Research, Vol. 21, No. 2JNK suppression of chemotherapeutic agents-induced ROS confers chemoresistance on pancreatic cancer stem cells19 November 2014 | Oncotarget, Vol. 6, No. 1Elevated DNA damage response in pancreatic cancer8 July 2014 | Histochemistry and Cell Biology, Vol. 142, No. 6Therapeutic Effects of an Anti-Myc Drug on Mouse Pancreatic Cancer11 October 2014 | JNCI: Journal of the National Cancer Institute, Vol. 106, No. 12Association of melanoma with intraepithelial neoplasia of the pancreas in three patientsExperimental and Molecular Pathology, Vol. 97, No. 1Targeting the K-Ras - 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This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.No writing assistance was utilized in the production of this manuscript.PDF download
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