Burden of pancreatic cancer in the Asia–Pacific region: Incidence, mortality, and modifiable risk attribution across Southeast Asia, East Asia, and Oceania (2000–2023).

e16362 Background: Pancreatic cancer has the highest mortality-to-incidence ratio among gastrointestinal malignancies, with rapidly escalating burden across Asia–Pacific regions. We quantified long-term epidemiologic trends, risk factor attribution, and treatment disparities in Southeast Asia, East Asia, and Oceania. Methods: Using Global Burden of Disease 2023 data, we analyzed pancreatic cancer incidence, mortality, prevalence, and disability-adjusted life years (DALYs) from 2000–2023 across 48 countries and territories (Southeast Asia: 11; East Asia: 6; Oceania: 31). Age-standardized rates and annual percent change (APC) were estimated. Risk attribution was assessed for tobacco use, alcohol consumption, high body-mass index (BMI), diabetes, and dietary factors. Regional treatment access and healthcare expenditure were evaluated. Results: In 2023, pancreatic cancer accounted for 248,600 incident cases and 236,400 deaths across the three regions, yielding a mortality-to-incidence ratio of 0.95 and contributing 5.87 million DALYs. Southeast Asia alone reported 112,300 cases and 106,200 deaths. Total incident cases increased from 143,600 in 2000 to 248,600 in 2023 (APC: 2.1%; 95% CI: 1.8%–2.4%). Age-standardized incidence rates were highest in East Asia (12.6–18.4 per 100,000) compared with Southeast Asia (6.8–11.2 per 100,000), while Oceania demonstrated the highest regional incidence (22.3 per 100,000 in high-income Pacific nations). Mortality-to-incidence ratios exceeded 0.94 in all regions, substantially higher than reported in Western countries (~0.85). Modifiable risk factors accounted for 38.6% of DALYs, driven by tobacco use (14.2%), high BMI (11.8%), diabetes (8.4%), and alcohol consumption (4.2%). Countries with structured diabetes registries and early detection programs (Japan, South Korea) demonstrated a 3.8% higher 5-year survival compared with countries lacking systematic surveillance. Surgical resection rates ranged from 18% in lower-income Southeast Asian countries to 52% in Japan, while per-patient healthcare expenditure varied from $8,200 USD to $47,600 USD across regions. Conclusions: Pancreatic cancer burden in Asia–Pacific regions has risen sharply over the past two decades, with persistently high mortality reflecting late-stage diagnosis and unequal access to curative treatment. Strengthening diabetes surveillance and tobacco control alone could mitigate approximately 23.4% of attributable pancreatic cancer burden, highlighting actionable prevention opportunities in rapidly aging Asian populations.