Pancreatic cancer mortality in Italy (1981–2015): a population-based study on geographic distribution and temporal trends

Background: Pancreatic cancer is the seventh leading cause of cancer deaths in industrialized countries globally and the fourth in Europe. It is a lethal malignancy with a 5-year survival rate of only 2–9%. Increasing incidence and mortality trends have been observed in both sexes in most countries. The International Agency for Research on Cancer (IARC) includes cigarette smoking, alcohol intake and red meat consumption among the risk factors causally associated with pancreatic cancer, although its aetiology still remains partially unknown. This is the first comprehensive study carried out on all Italian municipalities with a view to identifying high-risk areas, in terms of both mortality levels and temporal trends.Methods: We assessed the geographic distribution and the temporal trends of pancreatic cancer mortality in Italy between 1981 and 2015, in order to provide a comprehensive picture of this tumour’s distribution occurrence from national to municipal level; evaluate the contribution of some main aetiological factors; and, finally, identify municipalities at higher risk due to elevated mortality levels and/or increasing temporal trends.Results: Deaths from pancreatic cancer in people above age 35 were 137,579 for males, and 137,208 for females [standardized mortality rates (SMRates): 26.43 and 23.78 per 100,000 respectively]; increasing trends were observed in both sexes, although steeper progression was noted for females, mainly in younger age-classes (up to 64 years). A geographic mortality gradient from northern to southern municipalities was observed, although considerable differences were found when considering municipalities showing increasing trends, mostly located in southern and central Italy, in the case of males, and spread all over the peninsula, for females.Conclusions: The municipalities showing higher risk and the territories where these are more concentrated should be considered as priority areas for carrying out epidemiological studies aimed at evaluating the contribution of the risk factors involved, and possibly identifying other causes that still remain unknown.