Regional estimates of stomach cancer burden in Italy

AIMS AND BACKGROUND: Stomach cancer still remains one of the most frequent tumors in Italy and Europe. The aim of this paper is to present estimates for stomach cancer mortality, incidence and prevalence over the period 1970-2010 for the Italian regions and for Italy as a whole. METHODS: Estimated figures for incidence, prevalence and mortality were obtained by using the MIAMOD method. Starting from the knowledge of mortality in the period 1970-1999 and of relative survival in the period of diagnosis 1978-1994, we derived incidence and prevalence estimates and projections up to the year 2010 by means of a statistical back-calculation approach. Survival at the regional and national levels was modelled on the basis of published survival data from the Italian cancer registries. RESULTS: Incidence and mortality trends for both sexes decrease by about 60% during the estimation period 1970-2010. Both indicators show a 2-fold male/female ratio all over the country, and a similar gender time trend. The incidence and mortality in the North and Center of the country are estimated to be higher and to decrease more steeply than those in the South, both for men and women. A total of around 13,000 incident cases, 57,000 prevalent cases, and 8,000 deaths are estimated to have occurred in Italy in 2005. CONCLUSIONS: The incidence and mortality trends are estimated to decline during the entire period 1970-2010, with different slopes between northern-central and southern regions.The incidence and mortality are quite similar among Italian regions, showing that the risk of developing the disease diminishes and is becoming more homogeneous than in the past decades all over the country.     

Regional estimates of colorectal cancer burden in Italy

AIMS AND BACKGROUND: In terms of new diagnoses, colorectal cancer is one of the most important cancers in Italy and worldwide.The aim of this paper is to present estimates of the mortality, incidence and prevalence of colorectal cancer in Italy at a national and regional scale over the period 1970-1999, with projections up to 2010. METHODS: The estimates were obtained by applying the MIAMOD method, a statistical back-calculation approach to derive incidence and prevalence estimates from mortality and relative survival data. Published data from the Italian cancer registries were modelled to obtain regional and national estimates of colorectal cancer survival. RESULTS: Different incidence patterns were observed for men and women, especially in the projection period: the national age-standardized rate is estimated to increase throughout the study period 1970-2010 for men from 30 to 70 per 100,000, and to stabilize from the end of the 1990s for women at around 38 per 100,000. A stabilization or a slight decrease in age-standardized incidence rates is expected in most regions for women and in most northern-central regions for men. The most critical situation is estimated among men for southern regions, where the rise in incidence is accompanied by a dramatic increase in mortality. About 46,000 incident cases, 267,000 prevalent cases, and 16,000 deaths from colorectal cancer are estimated in Italy for the year 2005. CONCLUSIONS: Despite the risk reduction estimated in most northern-central regions among men and in the large majority of regions among women, the colorectal cancer burden in Italy is expected to remain relevant in the next years. Prospects for reducing this burden appear mainly connected to the adoption of prevention policies aimed at increasing the awareness of the risk related to dietary habits and lifestyles and at promoting colorectal cancer screening.     

Progress against laryngeal cancer in The Netherlands between 1989 and 2010

Cancer of the larynx is a frequently occurring head and neck cancer in The Netherlands. The main risk factors are smoking and excessive alcohol consumption. The aim of our study was to evaluate the progress against laryngeal cancer by studying trends in incidence, mortality and survival in The Netherlands. All patients in The Netherlands Cancer Registry diagnosed with invasive primary squamous cell carcinoma of the larynx during the period 1989–2010 were included for analysis. Time trends in incidence, mortality, treatment and survival were described for the total group and stratified by sex and subsite: glottis, supraglottis and subglottis. The most frequently affected subsite for men was the glottis (69%) and for women the supraglottis (55%). Glottic cancer was diagnosed at lower stages than supraglottic cancer. Incidence and mortality rates decreased for males with ?2.5 and ?2.8% per year, respectively, but remained stable for women, except for an increasing mortality rate in older women (EAPC: +2.5%). Five‐year relative survival rates were stable for glottic (85%) and supraglottic (50%) cancer, whereas patients with high‐staged cancers more often received radiotherapy. Multivariable analysis showed lower relative excess risks of dying for women, younger patients (<75 years), glottic cancer, lower stage cancer and those undergoing surgery. Changes in incidence and mortality rates are in line with changing smoking habits in The Netherlands. Declining incidence with stable survival rates gives rise to hope and worry at the same time.     

Regional estimates of prostate cancer burden in Italy

AIMS AND BACKGROUND: Prostate cancer is one of the most common cancers in developed countries and the most common among men in industrialized countries.The introduction of new diagnostic procedures caused an increase in new diagnoses in Italy starting from the early 1990s, while the prognosis of prostate cancer improved due to the use of hormonal treatments. The aim of this paper is to present estimates of prostate cancer mortality, incidence and prevalence over the period 1970-2005 for the Italian regions and for Italy as a whole, and to assess the changes that opportunistic screening and the diffusion of more effective treatments introduced. METHODS: Estimated figures for incidence, prevalence and mortality were obtained with the MIAMOD method. Starting from the knowledge of mortality in the period 1970-1999 and of the relative survival in the period of diagnosis 1978-1994, we derived incidence and prevalence estimates up to the year 2005 by means of a statistical back-calculation approach. Survival at regional and national levels was modelled on the basis of published survival data from the Italian cancer registries. RESULTS: The incidence trend showed a steep increase all over the country during the entire estimation period 1970-2005 with a more pronounced increase in the Center-North then in the South of Italy. Incidence of northern and central regions was about twice as high as that of southern regions. Mortality trends were however constant or declining in the majority of northern-central regions, while they still increased in the South. A total of around 43,000 incident cases, 174,000 prevalent cases and 9,000 deaths were estimated for Italy in 2005. DISCUSSION: The effects of opportunistic screening are reflected in an earlier diagnosis for many patients. The existing North-South gradient in incidence seems to be associated with the different spread of the PSA test in different parts of the country. Prostate cancer remains a great health problem in terms of both incidence and prevalence.     

Declining cancer rates in the 1990s.

PURPOSE: To provide evidence of a substantial decline in cancer rates for the period 1991 through 1995 and characterize major risk factors that seem to be driving secular trends in cancer mortality and incidence. DESIGN: Incidence and mortality rates were calculated using national surveillance data collected through the Surveillance, Epidemiology, and End Results (SEER) program and the National Center for Health Statistics. RESULTS: All-sites cancer incidence and mortality fell in the period 1991 through 1995; this decline is largely attributable to decreases in the smoking-related cancers, especially lung cancer. Of the 20 leading incident cancers today, both incidence and mortality are decreasing among 11 sites for men and 12 for women. In men, the decline in mortality has been notable and is especially apparent for the smoking-related cancers, including those of the lung, oral cavity and pharynx, larynx, and, to a lesser extent, bladder. In women, all-sites mortality decreased only approximately 0.4% from 1991 through 1995. Three cancers continued to show substantial increases in mortality through 1995 for both men and women (liver, multiple myeloma, and non-Hodgkin's lymphoma), while incidence rates continued to climb for liver cancer, non-Hodgkin's lymphoma, and melanoma. CONCLUSION: Data from the SEER program on recent trends in cancer incidence and mortality show that cancer rates are generally on the decline, largely because of reductions in smoking-related cancers. A consistent increase in mortality rates due to liver cancer poses a new health care challenge, one that will require the development of an effective treatment for individuals currently infected with hepatitis C or B to prevent mortality rates from continuing to increase.     

Sex differences in cancer risk and survival: A Swedish cohort study

AimThe aim of this study is to firmly delineate temporal and age trends regarding sex discrepancies in cancer risk and survival as well as quantifying the potential gain achieved by eliminating this inequality.MethodsWe performed a population-based cohort study using data on all adult incident cancer cases (n = 872,397) recorded in the Swedish Cancer Register in 1970–2014. To assess the associations between sex and cancer risk and sex and survival, male-to-female incidence rate ratios (IRRs) and excess mortality ratios (EMRs) adjusted for age and year of diagnosis were estimated using Poisson regression.ResultsMen were at increased risk for 34 of 39 and had poorer prognosis for 27 of 39 cancers. Women were at increased risk for 5 of 39 and had significantly poorer survival for 2 of 39 cancers. IRRs among male predominant sites ranged from 1.05; 95% confidence interval (CI), 1.03–-1.1 (lung adenocarcinoma) to 8.0; 95% CI, 7.5–8.5 (larynx). EMRs among sites with male survival disadvantage ranged from 1.1; 95% CI, 1.03–1.1 (colon) to 2.1; 95% CI, 1.5–-2.8 (well-differentiated thyroid).ConclusionMale sex is associated with increased risk and poorer survival for most cancer sites. Identifying and eliminating factors driving the observed sex differences may reduce the global cancer burden.     

Estimating regional cancer burden in countries with partial registration coverage: an application to all malignant neoplasms in Italy over the period 1970-2010

Regional epidemiological indicators of cancer burden are essential information for cancer surveillance and health resources planning, especially in countries with partial registration coverage and geographically variable risk patterns, such as Italy.This paper presents a methodology to derive cancer incidence and prevalence at the regional and national scale and illustrates its application to all malignant neoplasms in Italy for the period 1970–2010.The method, denoted as MIAMOD, is based on a back-calculation approach and derives cancer-specific morbidity measures by using official mortality data and model-based relative survival from local Cancer Registries data. The output includes time-trends and projections of a complete set of epidemiological indicators, i.e. mortality, incidence and prevalence.Results for all cancers in Italy show different incidence patterns by gender and a pronounced regional variability among men: male incidence is estimated to decrease in almost all northern-central regions, while more stable or even rising trends are estimated in the southern regions. No incidence reduction is expected for women. Prevalence increases country-wide in both sexes.The proposed approach can be applied to derive regional up-to-date time trends of cancer burden indicators in countries with local and sparse cancer registration systems. These estimates are useful for planning health services on a national and regional basis and for highlighting regional differences.     

中山市1970~2007年恶性肿瘤死亡分析

[目的]评价中山市1970～2007年恶性肿瘤死亡流行特征,为中山市肿瘤防治提供科学依据。[方法]收集整理中山市1970～2007年恶性肿瘤死亡资料,分析其死亡数、粗死亡率、中国和世界标化死亡率、死亡构成和顺位等指标。[结果]1970～2007年中山市恶性肿瘤世界标化死亡率为91.45/10万。男性肺、肝、食管、喉与肝外胆管等恶性肿瘤以及女性肺、结肠和子宫体癌死亡率明显上升。[结论]1970～2007年中山市恶性肿瘤死亡率明显上升,应加强中山市恶性肿瘤的防治。     

Regional estimates of breast cancer burden in Italy

AIMS AND BACKGROUND: Breast cancer is the most common cancer and the leading cause of cancer death among women. Knowledge of the present and future burden of the disease at a regional and national scale is a major issue in Italy, where the frequency and coverage of screening programs vary considerably across the country. This study presents estimates and projections of the female breast cancer incidence, prevalence and mortality for Italy and all Italian regions in the period 1970-2010. METHODS: The estimates were obtained by applying the MIAMOD method, a statistical back-calculation approach to derive incidence and prevalence figures from mortality and relative survival data. Published data from the Italian cancer registries were modelled to obtain regional and national estimates of breast cancer survival. RESULTS: Breast cancer mortality has been declining from the late 1980s in the northern-central regions and from the mid 1990s in the southern regions Puglia, Sicilia and Sardegna. Stable mortality rates are estimated for the other southern regions in the 2000's first decade. The incidence rate in Italy is estimated as increasing until the late 1990s, and stable thereafter (93 per 100,000). The incidence curve is also estimated to flatten in many northern-central regions from the late 1990s or later. Rising incidence trends are estimated in all southern regions, with the exception of Puglia. About 8,500 deaths, 37,000 new diagnoses and 416,000 prevalent cases for breast cancer are estimated among Italian women in 2005. In the same year, the proportion of prevalent cases in the northern area (1221 per 100,000) is about twice that estimated in the South (685 per 100,000). DISCUSSION: The geographical variation in female breast cancer burden can be explained by the unequal distribution of screening. A more widespread screening activity in the southern regions would help to bridge the gap between northern-central and southern regions. Continuous monitoring of regional epidemiological indicators for breast cancer is crucial to evaluate the effect of different health measures taken to control breast cancer in Italy.     

山东省1970—2005年肺癌死亡率变化趋势

目的：分析山东省1970—2005年肺癌死亡率及其变化趋势。方法:利用1970—2005年期间的四次全死因调查资料,计算肺癌死亡率和世界人口构成的标化死亡率;利用Joinpoint 回归软件计算肺癌死亡率的年均升降速率。结果:肺癌世界标化死亡率由1970—1974年的9.95（单位:/10万）,增加到2005年的34.88,年均增长速率为3.69%;其中男性则从13.46增加到47.78,年均增长速率为3.62%;女性则从6.59增加到23.31,年均增长速率为5.04%。男性肺癌死亡率高于女性。男女年龄组死亡率曲线变化趋势相同,随着年龄增长死亡率上升。城市肺癌死亡率明显高于农村。结论:排除抽样误差后,1970—2005年山东省肺癌死亡率呈上升趋势,位居主要恶性肿瘤死亡率之首位。     

Cancer incidence and mortality trends among whites in the United States, 1947-84

Cancer incidence trends from the late 1940s to 1983-84 were assessed among white residents of five geographic areas (Atlanta, Connecticut, Detroit, Iowa, San Francisco-Oakland) by means of data derived from several National Cancer Institute surveys, the Connecticut Tumor Registry, and the Surveillance, Epidemiology, and End Results Program. Incidence trends were compared with mortality trends for the entire United States and for the same five study areas. This study documented rising incidence and mortality rates for four cancers: lung cancer, melanoma of the skin, multiple myeloma, and non-Hodgkin's lymphomas. Increases in lung cancer continued through the early 1980s, but the rate of increase has been moderating during recent years, particularly among males and at younger ages for whom recent declines are evident. Overall, lung cancer incidence rates increased more than 220 and 400% among males and females, respectively. Although much rarer than lung cancer, melanoma of the skin and multiple myeloma increased greatly until the early 1980s among both males and females. The overall rate of increase in melanoma incidence among males was greater than that for lung cancer, and the rate of increase in multiple myeloma mortality among females was exceeded only by that for lung cancer. Increases of 70-120% were observed for non-Hodgkin's lymphomas. Increases in incidence and mortality rates for pancreatic cancer were apparent during the early years but less conspicuous in recent years. Laryngeal and kidney cancer rates generally increased substantially, although the changes were not remarkable for laryngeal cancer mortality among males and kidney cancer mortality among females. The rates for cancers of the mouth and pharynx increased among females but not males. Prostate, colon, and bladder cancer incidence rates increased more than 65% among males, whereas mortality rates changed only moderately. The incidence of thyroid cancer increased more than 75% among both sexes until the late 1970s, but mortality rates have declined during the period of study. Breast cancer incidence increased 30%, whereas mortality rates remained remarkably constant. The incidence of corpus uteri cancer increased dramatically during the mid-1970s and decreased substantially thereafter; these changes were not reflected in the mortality rates, which continually declined during the entire time period. The incidence of testicular cancer increased more than 90% and that of Hodgkin's disease did not change greatly; however, mortality rates for both cancers declined more than 50% since the late 1960s and early 1970s.(ABSTRACT TRUNCATED AT 400 WORDS)     

Trends in the incidence of cancer in the Sousse region,Tunisia, 1993–2006

In this article, we analyzed trends in incidence rates of the major cancer sites for a 14‐year period, 1993–2006, in the Sousse region localized in the centre of Tunisia. Five‐year age‐specific rates, crude incidence rates (CR), world age‐standardized rates (ASR), percent change (PC) and annual percent change (APC) were calculated using annual data on population size and its estimated age structure. A total of 6,975 incident cases of cancer were registered, with a male to‐female sex ratio of 1.4:1. ASRs showed stable trends (?0.1% in males, and +1.0% in females). The leading cancer sites in rank were lung, breast, lymphoma, colon‐rectum, bladder, prostate, leukemia, stomach and cervix uteri. For males, the incidence rates of lung, bladder and prostate cancers remained stable over time. While, cancers of colon‐rectum showed a marked increase in incidence (APC: +4.8%; 95% CI: 1.2%, 8.4%) and non‐Hodgkin's lymphoma (NHL) showed a notable decline (APC: ?4.4%; 95% CI: ?8.2, ?0.6). For females, cancers of the breast (APC: +2.2%; 95% CI: 0.4%, 4.0%) and corpus uteri (APC: +7.4%; 95% CI: 2.8%, 12.0%) showed a marked increase in incidence during the study period, while the cervix uteri cancer decreased significantly (APC: ?6.1%; 95% CI: ?9.2%, ?3.0%). The results underline the increasing importance of cancer as a cause of mortality and morbidity in Tunisia. Our findings justify the need to develop effective program aiming at the control and prevention of the spread of cancer amongst Tunisian population.     

Incidence and prevalence of all cancerous diseases in Italy: trends and implications

The burden of cancer in ageing populations is causing great concern, particularly in Italy with Europe's fastest growing elderly population. Studying all cancers combined in one group, although of limited medical value, is of great interest from the viewpoints of public health, epidemiology and the economy. Using mortality data and an estimate of cancer patients' survival we have estimated and projected incidence and prevalence in Italy of all cancers combined in one group. Five major phenomena are highlighted in the paper: (1) the decrease in the age-adjusted cancer mortality rates among females and the stable mortality rates among males since 1990; (2) the changing pattern of cancer incidence since 1990, it has started to decrease for females and is stabilising for males; (3) the decrease in cancer incidence among males and females born after 1940; (4) the increase in the proportion of cancer patients that are cured with calendar years of diagnosis; (5) the increase in the total and the healthy life expectancy (i.e. cancer-free) among the Italian population since 1970. The declining and flat trends in age-adjusted cancer incidence and mortality rates since 1990 is the combined effect of survival improvements and cancer risk reduction for younger cohort groups, after 1940. These favourable trends contribute to the increase in healthy life expectation, thus supporting the idea that we live longer and healthier.     

Regional estimates of all cancer malignancies in Italy

AIMS AND BACKGROUND: The aim of this paper is to present regional and national estimates of mortality, incidence and prevalence for all cancers in Italy over the period 1970-1999, with projections up to 2010. METHODS: The estimates were obtained by applying the MIAMOD method, a statistical back-calculation approach, to derive incidence and prevalence starting from mortality and relative survival data. Published data from the Italian Cancer Registries were modeled in order to estimate regional and national cancer survival. RESULTS: Cancer time trends resulted more favorable in northern-central regions than in southern regions, both for men and women. Mortality started to decrease in the northern-central area approximately from the mid 1980s, whereas it was expected to slightly decline only after the year 2000 in the southern area. Incidence was estimated to decrease in men from 1995 in northern and central areas only; no incidence reduction is expected for women during the study period. Overall, 130,000 cancer deaths, 250,000 new cancer cases and 1,700,000 prevalent cancer cases are estimated in Italy in the year 2005. CONCLUSIONS: This up-to-date picture of cancer risk and burden in the Italian regions shows as a relevant epidemiological change is ongoing in Italy. Although a clear geographical variability in mortality and morbidity levels still exists across the country, the historical North-to-South gap appears smaller than in the past. This change is particularly remarkable for men, as a consequence of trends that are favorable in northern-central regions but not yet in southern regions.     

Estimation and projections of stomach cancer trends in Italy

Mortality data from official sources, and survival data from population-based cancer registries, are used for the estimation of incidence and prevalence of stomach cancer. Time trends of morbidity, survival, and mortality during the period 1970–90 are presented and analyzed. Incidence rates were decreasing during the considered period, but the rate of decrease was slowing down during the last decade. Almost stable rates, and even slightly increasing for women, were estimated for the youngest cohorts. Relative survival for stomach cancer was higher for women and for young ages; it was associated positively with period of diagnosis, and presented a significant South-North geographic gradient. Prevalence was estimated as decreasing during the period 1970–80, but increasing during the successive decade, due to both better survival and population aging. Projection of stomach cancer morbidity and mortality to the year 2000 showed that the disease should still be considered in Italy as a major public health problem.This work was partially supported by the National Research Council (CNR), Progetto Finalizzato Oncologia (CNR.94.01254.PF39).     

Larynx cancer in Slovakia and the role of anatomical subsites

During the time period 1968–92, 6958 laryngeal cancers (6602 in men and 356 in women) were diagnosed in Slovakia and notified to the National Cancer Registry. We analysed long-term trends in incidence, mortality and survival. Mortality and incidence rates in Slovakian men rose rapidly until 1980 and more slowly subsequently. The mortality-to-incidence ratio initially was 40% and increased to 70% in the period 1985–88. A log-linear model showed that the more recent generations experienced the slowest increase in incidence. Incidence and mortality rates in women remained stable and did not exceed 1 per 100 000. The 5-year survival probability from invasive larynx cancer was 47%. Survival rates had shown no particular trend by year and age at diagnosis. The main finding was that 5-year survival from supraglottis cancer is 20% poorer than survival from glottis cancer. Supraglottis is the prevalent larynx subsite in countries with high larynx, oropharynx and oesophagus incidence rates. This supports the hypothesis that supraglottis cancer is more strongly linked to a synergistic effect of smoking and alcohol than glottis cancer.     

Evaluation of recent trends in cancer mortality and incidence among blacks

Recent trends in the cancer incidence, mortality, and 5-year survival rate for the black population were evaluated using the available national data up to 1981. Blacks have the highest overall age-adjusted cancer rates in both incidence and mortality of any US population group. The overall cancer incidence rates for blacks rose 17%, while for whites it increased 13% from 1969 to 1981. The rate in black men has increased 22.9%, while the rate in black women has increased 13.1%. The overall increase is the result of increases in cancers of the lung, prostate, colon-rectum, and esophagus. The age-specific incidence of lung cancer reflects the decrease of its incidence in those between 20 and 40 years of age because of the change in smoking habits after the Surgeon General's report on smoking. The overall cancer mortality rates for blacks increased 39% during the period. Lung cancer had the highest mortality rate, having increased more than 77.8% since 1969. This trend greatly reflects the recent increase in lung cancer incidence among black women. The overall 5-year cancer survival pattern for blacks was almost unchanged from 1973 to 1981, while whites had slightly higher survival rates during this period. However, blacks had substantial increases in survival rates for cancers of the esophagus and bladder during the period.     

Trends in the incidence of cancer in Qidong, China, 1978-2002

A population-based cancer registry was established in Qidong, Jiangsu Province, China, in 1972, and the trends in incidence rates of the major cancer sites have been analyzed for a 25-year period, 1978-2002. Five-year age-specific rates, crude incidence rates, world age-standardized rates (ASR), percent change (PC) and annual percent change (APC) were calculated using annual data on population size, and estimates of its age structure. The indices of histological verification of diagnosis, death certificate only and proportion of mortality to incidence were employed for assessing the registration quality. A total of 51,933 incident cases of cancer were registered in Qidong from years 1978 to 2002, with a male-to-female sex ratio of 1.9:1. Crude incidence increased markedly over the 25-year period (PC and APC of +55.6% and +2.1%, respectively), but ASR showed a slight decrease (-0.4% in males, and -0.3% in females), indicating that the major part of this is due to population ageing. The leading cancer sites in rank were liver (average ASR = 50.8 per 100,000), stomach (26.7), lung (22.7), colon-rectum (8.9), oesophagus (7.4) and breast (5.4). Cancers of liver, lung, colon-rectum and female breast all showed increases in incidence during the study period, with APCs (ASR) of +0.1%, +1.7% and +1.4% for males, and +0.2%, +0.9%, +1.9% and +1.1% for females, while the cancers of stomach (APC: -3.2% in male, and --2.4% in female) and cervix (APC: -4.7%) showed notable declines. Examination of age-specific rates showed declining trends in the younger generations for liver cancer, but increases for cervix cancer. The results underline the increasing importance of cancer as a cause of mortality and morbidity in a population that is ageing and undergoing profound changes in socioeconomic development and lifestyle. The cancers of high lethality that have been common in the Chinese population (liver, stomach, oesophagus) are showing some evidence of decline, at least in younger generations, but they remain major problems. At the same time, the cancers associated with economically "developed" societies -- lung, colon-rectum and female breast -- are showing increases. The population-based cancer registry is an indispensable tool for providing data for planning and evaluation of programmes for cancer control in all societies.     

Interpreting trends of pancreatic cancer incidence and mortality: a nation-wide study in Sweden (1960–2003)

Objective We investigated temporal trends of pancreatic cancer in Sweden measured with suboptimal sensitivity and specificity both by incidence and by mortality rates. Methods 46,257 incident cases of pancreatic cancer from the Swedish Cancer Register and 53,686 mortality cases from the Causes of Death Register during 1960–2003 were used to calculate age-standardized incidence or mortality rates. We further assessed the impact of changes in diagnostic practice on the observed trends, and investigated the effect of calendar period and birth cohort by age-period-cohort modeling. Results Overall, the pattern of trends in age-adjusted rates of pancreatic cancer was similar irrespective of whether incidence or mortality was used. The age-adjusted rates of pancreatic cancer increased during the first decade and then peaked for both sexes (the male peak occurred in the early 1970s and the female peak in the1980s) followed by a steady decline in both groups. An age-period model provided the best fit to the observed trends among patients diagnosed at ages 35–74 in both sexes. Conclusion The close agreement between the incidence and mortality and the gender disparity suggest a true decline in pancreatic cancer incidence in recent years in Sweden, and gender-specific trends in exposure to environmental risk factors.