CANCER of the PANCREAS

CANCER of the PANCREAS Data Highlights The highest 1991-95 average annual age-adjusted incidence rate for pancreatic cancer occurred in black males (14.1). Black females had the second highest rate (10.4). The rate of 8.6 for white males was 39 percent lower than the rate for black males. The rate for white females (6.4) was also approximately 39 percent lower than the rate for black females. A total of 1,427 cases of pancreatic cancer were diagnosed among residents of Pennsylvania in 1995 the highest annual number of cases recorded since statewide reporting began in 1985. Annual age-adjusted incidence rates by sex and race between 1986 and 1995 showed increasing rates for black males but no discernible trends among white males, white females or black females. There is very little information about the etiology of this disease except for cigarette smoking. Epidemiological studies have consistently shown an excess risk for smokers relative to nonsmokers. This risk increases with the amount of tobacco use. Smoking is directly responsible for about 25 percent of pancreatic cancer cases. Because nearly all cases are diagnosed at advanced stages, the five-year relative survival rates approach zero. In 1995 in Pennsylvania, 82.2 percent of all the cases were diagnosed at the regional or distant stages of the disease. While pancreatic cancer represented only 2.0 percent of all new cancer cases in 1995, it accounted for 4.8 percent of the cancer deaths that year. In fact, the 1991-95 average annual age-adjusted death rates for this site were higher than the average annual incidence rates among all four sex/race groups. This was also true for many of the annual numbers, age-specific and age-adjusted rates. This is possibly due to the problems of accurate assigning of the underlying cause of death and/or underreporting of incidence that are associated with this disease. Over the ten-year period of 1986 to 1995, there were no discernible long term trends in the annual death rates by sex or race. However, the rates for black females have been on the decline since 1993. FIGURE 7 Average Annual Age-Adjusted Incidence and Mortality Rates* by Sex and Race, Pennsylvania Residents, 1991-1995 Incidence Mortality Race/Sex All Cases/Deaths All Males All Females 7.7 8.1 9.0 9.5 8.6 9.2 6.8 7.1 6.4 6.8 10.4 10.6 14.1 14.2 0 5 10 15 Age-Adjusted Rate Risk Factors Cigarette smoking. Diet high in fat content is suggestive. *per 100,000 1970 U.S. standard million population. Early Detection None proven to be effective or currently being evaluated. Pennsylvania Department of Health - Pennsylvania Cancer Incidence and Mortality 1991-1995 - Page 68

Cancer of the Pancreas: INCIDENCE TABLE 7-A NUMBER OF CASES AND AGE-ADJUSTED INCIDENCE RATES BY SEX AND RACE, BY YEAR PENNSYLVANIA RESIDENTS, 1986-1995 M A L E S F E M A L E S ALL* CASES ALL RACES* WHITE BLACK ALL RACES* WHITE BLACK YEAR NO. RATE NO. RATE NO. RATE NO. RATE NO. RATE NO. RATE NO. RATE 1995 1,427 8.4 690 9.8 613 9.4 71 15.9 737 7.1 658 6.9 73 10.4 1994 1,291 7.6 653 9.4 584 9.0 64 14.6 638 6.2 585 6.2 49 7.0 1993 1,341 7.8 567 8.1 511 7.9 53 12.3 774 7.5 681 7.1 88 12.4 1992 1,279 7.5 618 8.9 549 8.5 63 14.5 661 6.5 576 6.0 80 11.9 1991 1,224 7.4 584 8.6 523 8.3 59 13.1 640 6.5 561 6.1 72 10.6 1990 1,228 7.5 604 9.0 556 8.9 45 10.6 624 6.4 538 5.8 80 12.5 1989 1,223 7.7 560 8.7 503 8.4 51 11.9 663 7.0 593 6.8 66 10.0 1988 1,111 7.1 544 8.4 495 8.2 48 11.2 567 6.1 510 5.9 55 8.6 1987 1,101 7.0 541 8.4 492 8.2 47 11.1 560 5.9 501 5.7 56 8.8 1986 1,180 7.5 549 8.5 504 8.4 43 10.2 631 6.8 569 6.6 61 9.9 * Includes any unknowns. NOTE: Age-adjusted rates are per 100,000 and are computed by the direct method using the 1970 U.S. standard million population. See technical notes. FIGURE 7-A AGE-ADJUSTED INCIDENCE RATES BY SEX AND RACE PENNSYLVANIA RESIDENTS, 1986-1995 18 16 14 RATE PER 100,000 12 10 8 6 4 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 YEAR Pennsylvania Department of Health - Pennsylvania Cancer Incidence and Mortality 1991-1995 - Page 69

Cancer of the Pancreas: INCIDENCE TABLE 7-B AVERAGE ANNUAL AGE-SPECIFIC INCIDENCE RATES BY SEX AND RACE M A L E S F E M A L E S AGE ALL GROUP CASES ALL RACES WHITE BLACK ALL RACES WHITE BLACK Total 10.9 10.8 10.8 11.6 11.0 11.0 11.9 Under 5 - - - - - - - 5-9 - - - - - - - 10-14 - - - - - - - 15-19 0.0 - - - 0.0 0.1-20-24 0.1 0.0 0.1-0.2 0.3-25-29 0.2 0.0 0.1-0.3 0.3 0.4 30-34 0.5 0.3 0.4-0.6 0.7-35-39 0.8 0.9 0.7 2.0 0.7 0.7 1.3 40-44 2.2 2.7 2.6 4.6 1.8 1.5 4.4 45-49 4.3 5.6 5.2 11.1 3.1 3.2 3.0 50-54 9.1 10.4 9.6 22.2 7.8 7.1 14.2 55-59 16.1 18.9 17.7 34.9 13.6 12.3 25.9 60-64 26.2 32.6 31.3 46.9 20.8 20.2 26.3 65-69 36.6 42.1 39.4 78.8 32.2 30.9 46.8 70-74 48.9 56.9 54.0 97.4 43.1 41.3 69.8 75-79 57.3 68.2 68.0 72.3 50.5 48.9 72.5 80-84 64.1 66.2 66.2 68.3 63.0 60.1 102.9 85+ 63.6 70.1 69.0 95.5 61.1 58.9 98.8 NOTE: Rates are per 100,000 population (1991-1995) for each specified group. FIGURE 7-B AVERAGE ANNUAL AGE-SPECIFIC INCIDENCE RATES BY SEX AND RACE 120 100 80 RATE PER 100,000 60 40 20 0 Under 5 5-9 10-14 20-24 30-34 40-44 50-54 60-64 70-74 80-84 15-19 25-29 35-39 45-49 55-59 65-69 75-79 AGE GROUP 85+ Pennsylvania Department of Health - Pennsylvania Cancer Incidence and Mortality 1991-1995 - Page 70

Cancer of the Pancreas: INCIDENCE TABLE 7-C TOTAL NUMBER OF CASES BY AGE, SEX AND RACE M A L E S F E M A L E S AGE ALL* GROUP CASES ALL RACES* WHITE BLACK ALL RACES* WHITE BLACK Total 6,562 3,112 2,780 310 3,450 3,061 362 Under 5 0 0 0 0 0 0 0 5-9 0 0 0 0 0 0 0 10-14 0 0 0 0 0 0 0 15-19 1 0 0 0 1 1 0 20-24 6 1 1 0 5 5 0 25-29 7 1 1 0 6 5 1 30-34 22 8 8 0 14 14 0 35-39 37 20 15 4 17 14 3 40-44 98 59 51 8 39 29 9 45-49 159 100 85 15 59 54 5 50-54 279 154 130 24 125 102 20 55-59 446 248 213 33 198 162 33 60-64 734 420 373 41 314 278 32 65-69 1,031 525 457 64 506 449 53 70-74 1,207 589 523 60 618 551 65 75-79 1,095 503 471 30 592 536 52 80-84 796 284 267 16 512 458 49 85+ 644 200 185 15 444 403 40 * Includes any unknowns. FIGURE 7-C STAGE OF DISEASE AT DIAGNOSIS, PERCENT BY SEX AND RACE PENNSYLVANIA RESIDENTS, 1995 50 42.8 42.8 43.8 42.5 44.8 In Situ Local 40 37.7 Regional Distant 32.8 32.8 30 PERCENT 20 23.4 19.7 22.4 14.4 10 0 0.2 NUMBER AND PERCENT OF CASES MICROSCOPICALLY CONFIRMED: 1,130-79.2% Pennsylvania Department of Health - Pennsylvania Cancer Incidence and Mortality 1991-1995 - Page 71

Cancer of the Pancreas: MORTALITY TABLE 7-D NUMBER OF DEATHS AND AGE-ADJUSTED DEATH RATES BY SEX AND RACE, BY YEAR PENNSYLVANIA RESIDENTS, 1986-1995 M A L E S F E M A L E S ALL* DEATHS ALL RACES* WHITE BLACK ALL RACES* WHITE BLACK YEAR NO. RATE NO. RATE NO. RATE NO. RATE NO. RATE NO. RATE NO. RATE 1995 1,452 8.1 679 9.5 602 9.1 75 16.8 773 7.1 713 7.0 58 8.0 1994 1,409 7.9 645 9.1 576 8.7 68 15.5 764 7.0 695 6.8 64 9.2 1993 1,391 8.0 641 9.1 583 8.9 57 12.9 750 7.1 661 6.7 86 12.5 1992 1,467 8.4 696 10.0 625 9.6 69 15.9 771 7.2 664 6.7 100 14.3 1991 1,404 8.2 663 9.7 618 9.7 43 9.8 741 7.1 672 6.9 65 9.1 1990 1,377 8.2 683 10.1 618 9.8 65 15.2 694 6.8 614 6.4 78 12.2 1989 1,428 8.8 651 10.0 589 9.7 59 13.9 777 7.8 705 7.7 67 9.8 1988 1,233 7.6 587 9.0 536 8.8 49 11.7 646 6.6 587 6.5 59 9.1 1987 1,314 8.1 620 9.6 561 9.3 58 14.0 694 7.0 632 6.8 61 9.5 1986 1,322 8.3 597 9.2 562 9.3 34 8.2 725 7.5 637 7.0 86 14.0 * Includes any unknowns. NOTE: Age-adjusted rates are per 100,000 and are computed by the direct method using the 1970 U.S. standard million population. See technical notes. FIGURE 7-D AGE-ADJUSTED DEATH RATES BY SEX AND RACE PENNSYLVANIA RESIDENTS, 1986-1995 18 16 14 RATE PER 100,000 12 10 8 6 4 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 YEAR Pennsylvania Department of Health - Pennsylvania Cancer Incidence and Mortality 1991-1995 - Page 72

Cancer of the Pancreas: MORTALITY TABLE 7-E NUMBER OF DEATHS AND AVERAGE ANNUAL AGE-SPECIFIC DEATH RATES BY SEX AND RACE M A L E S F E M A L E S ALL* AGE DEATHS ALL RACES* WHITE BLACK ALL RACES* WHITE BLACK GROUP NO. RATE NO. RATE NO. RATE NO. RATE NO. RATE NO. RATE NO. RATE TOTAL* 7,123 11.8 3,324 11.5 3,004 11.7 312 11.7 3,799 12.2 3,405 12.3 373 12.3 UNDER 5 0-0 - 0-0 - 0-0 - 0-5-9 0-0 - 0-0 - 0-0 - 0-10-14 0-0 - 0-0 - 0-0 - 0-15-19 0-0 - 0-0 - 0-0 - 0-20-24 1 0.0 0-0 - 0-1 0.0 1 0.1 0-25-29 2 0.0 1 0.0 1 0.1 0-1 0.0 1 0.1 0-30-34 17 0.4 6 0.3 6 0.3 0-11 0.5 11 0.5 0-35-39 20 0.4 12 0.5 10 0.5 2 1.0 8 0.3 6 0.3 2 0.9 40-44 87 2.0 54 2.5 46 2.4 8 4.6 33 1.5 26 1.3 7 3.4 45-49 159 4.3 104 5.8 92 5.6 12 8.9 55 2.9 50 2.9 5 3.0 50-54 255 8.3 140 9.5 124 9.2 16 14.8 115 7.2 98 6.8 15 10.7 55-59 428 15.5 230 17.6 196 16.3 33 34.9 198 13.6 169 12.8 28 22.0 60-64 698 24.9 413 32.0 367 30.8 43 49.2 285 18.9 244 17.8 35 28.7 65-69 1,061 37.6 554 44.4 487 42.0 64 78.8 507 32.3 445 30.7 60 53.0 70-74 1,251 50.7 595 57.5 535 55.2 59 95.8 656 45.8 585 43.8 68 73.0 75-79 1,263 66.1 587 79.6 549 79.2 38 91.6 676 57.7 621 56.6 53 73.9 80-84 969 78.1 348 81.2 334 82.8 14 59.7 621 76.4 563 73.8 54 113.4 85+ 912 90.1 280 98.2 257 95.8 23 146.5 632 86.9 585 85.4 46 113.6 * Includes any unknowns. NOTE: Rates are per 100,000 population (1991-1995) for each specified group. FIGURE 7-E AVERAGE ANNUAL AGE-SPECIFIC DEATH RATES BY SEX AND RACE 200 150 RATE PER 100,000 100 50 0 UNDER 5 5-9 10-14 15-19 20-24 25-29 30-34 40-44 50-54 35-39 45-49 AGE GROUP 55-59 60-64 65-69 70-74 75-79 80-84 85+ Pennsylvania Department of Health - Pennsylvania Cancer Incidence and Mortality 1991-1995 - Page 73

Cancer of the Pancreas: INCIDENCE TABLE 7-F TOTAL NUMBER OF CASES AND AVERAGE ANNUAL AGE-ADJUSTED INCIDENCE RATES* BY COUNTY AND SEX M A L E S F E M A L E S M A L E S F E M A L E S TOTAL TOTAL COUNTY CASES NO. RATE NO. RATE COUNTY CASES NO. RATE NO. RATE ALL COUNTIES 6,562 3,112 9.0 3,450 6.8 ADAMS 41 19 8.4 22 7.1 JUNIATA 8 3 4.6 5 7.2 ALLEGHENY 833 380 9.2 453 7.0 LACKAWANNA 135 55 7.8 80 6.9 ARMSTRONG 52 30 12.0 22 5.3 LANCASTER 174 82 7.1 92 5.6 BEAVER 123 60 9.8 63 7.2 LAWRENCE 50 25 7.4 25 5.6 BEDFORD 25 14 9.0 11 5.1 LEBANON 64 31 8.8 33 6.3 BERKS 171 86 8.3 85 5.8 LEHIGH 150 75 8.6 75 6.1 BLAIR 70 33 8.4 37 6.7 LUZERNE 233 106 10.1 127 7.5 BRADFORD 35 21 11.3 14 5.4 LYCOMING 49 22 6.7 27 5.6 BUCKS 225 104 7.7 121 6.5 MCKEAN 23 11 7.0 12 5.9 BUTLER 72 37 8.4 35 6.0 MERCER 73 31 8.0 42 6.9 CAMBRIA 108 54 9.7 54 6.8 MIFFLIN 25 9 6.5 16 7.0 CAMERON 2 1 5.6 1 2.7 MONROE 55 32 10.6 23 6.2 CARBON 30 17 8.1 13 5.5 MONTGOMERY 419 208 10.2 211 7.0 CENTRE 29 14 5.4 15 4.2 MONTOUR 8 4 8.4 4 5.1 CHESTER 153 92 9.8 61 5.1 NORTHAMPTON 128 62 8.5 66 6.2 CLARION 24 16 13.3 8 5.1 NORTHUMBERLAND 57 28 8.3 29 5.4 CLEARFIELD 44 18 7.1 26 6.6 PERRY 16 9 8.7 7 4.8 CLINTON 13 5 4.8 8 5.3 PHILADELPHIA 1,049 469 11.9 580 8.9 COLUMBIA 32 15 8.1 17 7.4 PIKE 13 10 9.5 3 2.9 CRAWFORD 38 22 8.5 16 3.8 POTTER 5 4 7.4 1 1.2 CUMBERLAND 79 45 8.1 34 4.1 SCHUYLKILL 93 44 8.6 49 6.0 DAUPHIN 146 64 10.0 82 9.4 SNYDER 14 7 7.0 7 6.0 DELAWARE 265 122 7.9 143 6.1 SOMERSET 36 14 5.8 22 6.0 ELK 21 8 7.5 13 8.5 SULLIVAN 5 0-5 16.0 ERIE 129 54 7.2 75 7.3 SUSQUEHANNA 15 5 3.9 10 4.8 FAYETTE 76 36 7.6 40 5.5 TIOGA 16 8 6.2 8 4.8 FOREST 3 2 8.1 1 3.3 UNION 19 8 8.5 11 9.5 FRANKLIN 58 29 7.8 29 5.9 VENANGO 38 22 12.7 16 6.2 FULTON 9 6 14.8 3 7.7 WARREN 21 12 8.5 9 4.5 GREENE 13 9 6.9 4 2.9 WASHINGTON 122 57 8.4 65 7.1 HUNTINGDON 22 14 11.3 8 4.3 WAYNE 39 16 12.0 23 10.9 INDIANA 30 16 6.2 14 4.1 WESTMORELAND 240 112 9.0 128 7.8 JEFFERSON 41 16 9.4 25 9.8 WYOMING 14 5 7.4 9 9.1 YORK 144 67 7.1 77 6.0 * Age-adjusted rates are per 100,000 and are computed by the direct method using the 1970 U.S. standard million population. See technical notes regarding reliability of rates. Pennsylvania Department of Health - Pennsylvania Cancer Incidence and Mortality 1991-1995 - Page 74

Cancer of the Pancreas: MORTALITY TABLE 7-G TOTAL NUMBER OF DEATHS AND AVERAGE ANNUAL AGE-ADJUSTED DEATH RATES* BY COUNTY AND SEX M A L E S F E M A L E S M A L E S F E M A L E S TOTAL TOTAL COUNTY DEATHS NO. RATE NO. RATE COUNTY DEATHS NO. RATE NO. RATE ALL COUNTIES 7,123 3,324 9.5 3,799 7.1 ADAMS 47 24 10.7 23 7.0 JUNIATA 7 4 6.8 3 5.6 ALLEGHENY 859 378 9.1 481 7.2 LACKAWANNA 165 69 9.5 96 7.3 ARMSTRONG 51 29 11.1 22 5.2 LANCASTER 207 95 8.3 112 6.6 BEAVER 114 59 9.3 55 6.2 LAWRENCE 56 28 8.4 28 5.5 BEDFORD 26 11 6.8 15 7.0 LEBANON 71 27 7.3 44 8.3 BERKS 178 88 8.4 90 6.0 LEHIGH 175 82 9.2 93 7.2 BLAIR 76 33 8.1 43 7.3 LUZERNE 239 112 10.3 127 6.8 BRADFORD 43 23 12.2 20 6.1 LYCOMING 61 26 7.7 35 6.7 BUCKS 249 116 8.6 133 7.2 MCKEAN 26 14 8.7 12 4.9 BUTLER 70 34 7.9 36 6.1 MERCER 91 37 9.4 54 8.5 CAMBRIA 113 56 9.8 57 6.7 MIFFLIN 27 8 5.7 19 7.4 CAMERON 3 2 10.2 1 2.7 MONROE 68 38 13.1 30 7.8 CARBON 32 20 9.9 12 4.8 MONTGOMERY 448 211 10.2 237 7.4 CENTRE 35 14 5.4 21 5.9 MONTOUR 12 8 16.1 4 5.1 CHESTER 172 96 10.1 76 6.0 NORTHAMPTON 145 62 8.6 83 7.6 CLARION 21 12 9.8 9 5.3 NORTHUMBERLAND 65 33 10.0 32 5.9 CLEARFIELD 46 22 8.7 24 5.8 PERRY 16 11 10.5 5 3.3 CLINTON 15 7 6.4 8 4.5 PHILADELPHIA 1,086 476 11.9 610 8.8 COLUMBIA 36 13 6.8 23 9.6 PIKE 19 12 12.0 7 6.0 CRAWFORD 50 31 12.0 19 4.6 POTTER 10 4 7.9 6 7.7 CUMBERLAND 88 48 8.7 40 4.9 SCHUYLKILL 109 53 10.0 56 7.1 DAUPHIN 143 61 9.5 82 9.0 SNYDER 16 5 5.1 11 9.1 DELAWARE 322 141 9.0 181 7.4 SOMERSET 45 23 8.9 22 5.5 ELK 19 8 7.7 11 6.9 SULLIVAN 2 0-2 5.6 ERIE 148 66 8.7 82 7.5 SUSQUEHANNA 19 8 6.4 11 5.3 FAYETTE 84 43 9.1 41 5.4 TIOGA 27 17 13.1 10 6.1 FOREST 4 2 8.1 2 6.5 UNION 24 12 12.6 12 10.5 FRANKLIN 69 29 7.6 40 7.6 VENANGO 35 21 12.0 14 4.9 FULTON 11 9 22.1 2 4.7 WARREN 27 13 9.4 14 6.3 GREENE 19 10 8.3 9 6.5 WASHINGTON 123 61 9.2 62 6.6 HUNTINGDON 21 14 11.4 7 3.3 WAYNE 38 15 11.7 23 10.5 INDIANA 37 19 7.2 18 4.8 WESTMORELAND 247 126 10.0 121 7.0 JEFFERSON 43 13 7.9 30 12.5 WYOMING 20 14 19.5 6 6.9 YORK 153 68 7.2 85 6.5 * Age-adjusted rates are per 100,000 and are computed by the direct method using the 1970 U.S. standard million population. See technical notes regarding reliability of rates. Pennsylvania Department of Health - Pennsylvania Cancer Incidence and Mortality 1991-1995 - Page 75