Josh Friedman , 2025-05-08 11:00:00
Key takeaways:
- Rates of pancreatic adenocarcinoma increased significantly among younger individuals than older ones.
- Colorectal adenocarcinoma diagnoses also have increased among patients aged 15 to 34 years.
Cases of pancreatic cancer have increased significantly among younger individuals compared with those aged 35 years and older during the past 2-plus decades, according to results of a retrospective study published in JAMA Network Open.
The annual rate of diagnoses in patients aged 15 to 34 years rose more than 4% from 2000 to 2021, findings showed.
Arvind J. Trindade
“It’s really important that clinicians are aware of this trend ,” Arvind J. Trindade, MD, FACG, FASGE, co-chief of endoscopy at Robert Wood Johnson University Hospital at Rutgers Health and vice president of gastrointestinal clinical operations for RWJBarnabas Health System-Southern Region, told Healio. “It’s important that when they’re examining younger individuals with abdominal pain and red-flag symptoms that they’re aware of this study, they ask pertinent questions and perform the appropriate workup so that pancreatic cancer has not gone undiagnosed for too long.”
‘Hits home every time’
Pancreatic cancer incidence has doubled in the past 25 years and has a 5-year survival rate of about 10%, according to study background.
It is the seventh leading cause of global cancer deaths.
Historically, pancreatic cancer developed in older individuals, but data over the past decade suggest an increased incidence among younger patients.
Trindade, an interventional gastroenterologist, has observed that anecdotally, as well, performing more endoscopic ultrasounds with pancreas biopsy on younger people.
“I’m 45 years old, and so it hits home every time,” he said. “There’s a 40-year-old or a 30-year-old that you’re being sent to diagnose pancreatic cancer, and I’m like, ‘Oh, my gosh’ and, ‘Thank my lucky stars this is not me.’”
These experiences prompted Trindade and colleagues to further investigate pancreatic and colorectal cancer trends.
They used the SEER database to evaluate pancreatic and colorectal adenocarcinoma incidence from 2000 to 2021.
The researchers identified 275,273 cases (87.1% aged 55 years and older; 51.8% men; 91.8% white) of pancreatic adenocarcinoma and 1,215,200 diagnoses (80.4% aged 55 years and older; 52.8% men; 81.1% white) of colorectal adenocarcinoma.
Annual percentage changes of pancreatic and colorectal adenocarcinoma incidence based on age served as the primary endpoint.
‘That’s huge’
Pancreatic adenocarcinoma incidence increased among all age groups.
Most cases occurred among patients aged 55 years and older (n = 239,840), followed by those aged 35 to 54 years (n = 33,800) and those aged 15 to 34 years (n = 1,633).
However, individuals aged 15 to 34 years had a significantly higher annual percentage change (4.35%; 95% CI, 2.03%-6.73%) than those aged 35 to 54 years (1.54%; 95% CI, 1.18%-1.9%) and those aged 55 years and older (1.74%; 95% CI, 1.59%-1.89%).
“That’s huge,” Trindade said of the change among younger patients. “Obviously the overall incidence is going to be higher in the older age group, but the fact that the annual percentage change is dramatically increased in the younger population really tells us that we need to be paying attention to this trend.”
Individuals aged 55 years and older also had the highest number of colorectal cancer diagnoses (n = 976,716), followed by those aged 35 to 54 years (n = 224,591) and those aged 15 to 34 years (n = 13,893).
The annual percentage change decreased among individuals aged 55 years and older (–3.31%; 95% CI, –3.54% to –3.08%) — a significant difference compared with increases seen among those aged 15 to 34 years (1.75%; 95% CI, 1.08%-2.42%) and those aged 35 to 54 years (0.78%; 95% CI, 0.51%-1.06%).
“That wasn’t as surprising for me,” Trindade said. “We decreased the interval by 5 years [on when to get screened] due to this known observation. Over the years, we’ve been seeing more and more 50-year-olds with higher risk polyps, so when we saw the data showing 40-year-olds, 45-year-olds may be developing high-risk lesions, polyps and early cancers, it wasn’t as surprising to me.”
Researchers acknowledged study limitations, including the SEER database representing less than half of the population.
‘It could be a cancer’
Trindade emphasized clinicians should not assume younger individuals have pancreatic cancer if they present with vague symptoms of epigastric pain, however it should be on their radar.
“I think usually we would say, ‘Take antacid medication,’ and if it’s working, [continue],” he said. “If it’s not working, try something maybe less invasive, and then go from there.”
Symptoms such as weight loss, anemia, and a family history of pancreatic cancer, should indicate that a patient may need further evaluation.
“These are all things that historically you wouldn’t investigate in a young individual, but now things that you want to make sure you’re not missing,” Trindade said. “If any of those come back as positive, then you may want to consider ordering imaging to see if there’s anything brewing in the pancreas.”
Future prospective research is needed to investigate risk factors associated with developing pancreatic cancer at a young age.
Additionally, Trindade noted health systems need to be equipped with tools like endoscopic ultrasound with pancreas biopsy to manage the increase among younger patients who may have pancreatic cancer or to screen high risk individuals.
“[Pancreatic cancer] has to be in our radar [for younger patients],” he said. “We have to be thinking as physicians that maybe it could be a cancer.”
For more information:
Arvind J. Trindade, MD, FACG, FASGE, can be reached at arvind.trindade@gmail.com.
Sources/Disclosures
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Disclosures:
Trindade reports personal fees from Boston Scientific, Exact Science and Lucid Diagnostics. Please see the study for all other authors’ relevant financial disclosures.
