title: The epidemiology of pancreatic cancer in the United States: changes below the surface.
abstract: BACKGROUND
  Pancreatic cancer is the fourth leading cause of cancer death in the United States.
  
  
  OBJECTIVE
  To examine temporal changes in the incidence and survival of patients with pancreatic adenocarcinoma.
  
  
  METHODS
  Using data from nine registries of the Surveillance, Epidemiology and End Results programme, age-adjusted incidence rates per 100 000 and survival rates were calculated for pancreatic cancer between 1977 and 2001.
  
  
  RESULTS
  We identified 58 655 cases of pancreatic cancer. The age-adjusted incidence rate remained stable during the study period (11.3 in 1977-1981 and 10.9 in 1997-2001). Overall, men were 30% more affected than women (age-adjusted incidence rate of 13.0 in men and 9.8 in women). The age-adjusted incidence rates were almost 50% higher among Blacks (16.4) than Whites (10.8) and people of other races (9.8). Over time the proportions of patients with localized disease decreased from 12.3% to 7.4% and those with regional disease increased from 18.6% to 25.8%, while metastatic disease remained stable (52.5% vs. 49.8%). The 1-year relative survival increased from 15.2% in 1977-1981 to 21.6% in 1997-2001.
  
  
  CONCLUSIONS
  The incidence of pancreatic cancer is stable. A shift from localized to regional disease was observed over time. The overall survival remains poor despite important improvements among patients with early stage disease.
authors.affiliation: Section of Health Services Research, Michael E. Debakey Veterans Affairs Medical Center, Houston, TX 77030, USA. yshaib@bcm.tmc.edu
authors.forename: Y H
authors.initials: YH
authors.lastname: Shaib
authors.forename: J A
authors.initials: JA
authors.lastname: Davila
authors.forename: H B
authors.initials: HB
authors.lastname: El-Serag
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology*; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D015999:Multivariate Analysis; D010190:Pancreatic Neoplasms / Q000208:ethnology / Q000401:mortality*; D044469:Racial Groups; D012307:Risk Factors; D017678:Sex Distribution; D015996:Survival Rate; D014481:United States / Q000453:epidemiology