Trends and persistent disparities in incidence, mortality, and survival of pancreatic cancer: A Surveillance, Epidemiology, and End Results program–based retrospective cohort study (2000–2021).

e16360 Background: Pancreatic cancer remains a highly lethal malignancy with increasing incidence and mortality, compounded by significant survival disparities across demographic groups. This study evaluates trends in pancreatic cancer incidence, mortality, and survival, emphasizing disparities by sex, stage, and race/ethnicity using SEER data from 2000–2021. Methods: This retrospective cohort study utilized SEER 22 registry data to analyze delay-adjusted incidence, mortality, and 5-year relative survival rates. Trends were assessed using Joinpoint Regression software to calculate Annual Percent Change (APC) for specific time intervals and Average Annual Percent Change (AAPC) for overall trends. Survival differences for cases diagnosed between 2014 and 2020 were stratified by stage and race/ethnicity. Results: From 2000–2021, the incidence of pancreatic cancer increased significantly with an APC of 1.2% (2000–2012) and 0.8% (2012–2021) for males, resulting in an overall AAPC of 0.9% (p < 0.01). For females, incidence rose with an APC of 1.0% (2000–2013) and 0.6% (2013–2021), resulting in an AAPC of 0.8% (p < 0.01). Mortality trends mirrored incidence, with a male mortality APC of 1.3% (2000–2012) and 0.7% (2012–2021) (AAPC: 0.9%, p < 0.01) and a female mortality APC of 1.1% (2000–2013) and 0.5% (2013–2021) (AAPC: 0.8%, p < 0.01). Survival outcomes also revealed stark disparities, the 5-year relative survival rate for localized disease was highest among Hispanics (46.4%) and non-Hispanic Whites (43.1%), while non-Hispanic American Indian/Alaska Native patients had the lowest localized survival (31.9%). For regional-stage disease, survival was lower among non-Hispanic Black patients (14.8%) compared to non-Hispanic Whites (16.3%). Survival for distant-stage disease remained uniformly poor ( < 4%) across all groups. Unstaged cases showed extreme disparities, with non-Hispanic American Indian/Alaska Native patients having a 0% survival rate. Conclusions: Pancreatic cancer incidence and mortality are rising, with stark racial and ethnic disparities in survival outcomes. Non-Hispanic Black and non-Hispanic American Indian/Alaska Native populations face the greatest inequities, highlighting the need for targeted interventions and equitable access to care.