Analysis of incidence, mortality and survival for pancreatic and biliary tract cancers across Europe, with assessment of influence of revised European age standardisation on estimates

Background: Pancreatic (PC) and biliary tract (BTC) cancers have higher incidence and mortality in Europe than elsewhere. We analysed time-trends in PC/BTC incidence, mortality, and survival across Europe. Since the European standard population (ESP) was recently revised to better represent European age structure, we also assessed the effect of adopting the revised ESP to age-standardise incidence and mortality data. Methods: We analysed PCs/BTCs (≥15 years) diagnosed in 2000–2007 and followed-up to end of 2008, in 29 European countries across five regions: UK/Ireland, and northern, central, southern, and eastern Europe. Incidence, mortality, and 5-year relative survival were compared between regions, by age, sex, and period of diagnosis. Results: Variation in age-standardised incidence (PC 12–15/100,000; BTC 2–6) and mortality (PC 10–14; BTC 1–5) was modest. Eastern Europe had highest incidence and mortality, and lowest survival; northern and southern Europe had highest age-specific incidence (most age groups) for PC and BTC, respectively. Incidence and survival increased slightly from 2000 to 2007, particularly in elderly patients and women, but survival remained poor (≤8% for PC; 13–18% for BTC). Use of the revised ESP for age-standardisation did not impact European regional incidence and mortality rankings. Conclusion: Poor survival for PC and BTC, together with increasing incidence, indicate that action is required. Countries with higher incidence had higher risk factor frequency, suggesting that prevention initiatives targeting risk factors should be promoted. Improvements in diagnosis and treatment are also required. Our results provide a baseline from which to monitor evolution of the PC/BTC burden in Europe.