Burden of pancreatic cancer in Iran: an analysis of Global Burden of Disease 2021.

Abstract

Aim: To assess national and provincial trends in pancreatic cancer (PC) incidence, mortality, and mortality-to-incidence ratio (MIR) in Iran (1990-2021) using Global Burden of Disease (GBD) 2021 data.

Background: PC is highly lethal, and recent burden estimates for Iran are limited.

Methods: Age-standardized and age-specific incidence and mortality rates were obtained from the GBD Results Tool; MIR was calculated. Joinpoint regression was used to estimate average annual percentage change (AAPC) overall, by sex, and in adults aged ≥55 years.

Results: From 1990 to 2021, age-standardized incidence and mortality increased by 80% (1.98 to 3.57 per 100,000) and 73% (2.12 to 3.65 per 100,000), respectively, while the MIR declined slightly (1.07 to 1.02) but remained above 1. Among adults ≥55 years, incidence and mortality nearly doubled (8.31 to 16.84 and 8.73 to 17.38 per 100,000, respectively), with minor MIR reductions (1.05 to 1.03). Joinpoint regression confirmed significant national increases in incidence (AAPC:1.88%) and mortality (AAPC:1.73%), alongside a modest decline in MIR (AAPC:-0.14%). Provincially, all regions exhibited rising age-standardized incidence and mortality, most steeply in Ilam and the lowest in Tehran. MIR generally declined, notably in Tehran, Lorestan, and Chaharmahal and Bakhtiari, though slight increases occurred in South/North Khorasan, Markazi, and Sistan and Baluchestan.

Conclusion: PC burden in Iran has increased subs`tantially over the past three decades, especially among older adults and in certain provinces. Persistently high MIR indicates late diagnosis and poor survival, highlighting the need to strengthen cancer registries, improve early detection and diagnostic capacity, and address modifiable risk factors.