Has early detection improved?: Trends in localized PDAC diagnoses in the U.S. (2004-2022).

Abstract

e16454 Background: Pancreatic ductal adenocarcinoma (PDAC) remains one of the deadliest cancers in the United States; most patients are not diagnosed until they present with symptomatic, advanced-stage disease. However, advances in imaging, endoscopic techniques, biomarker development, liquid biopsy, and high-risk screening programs may have helped shift detection toward earlier stages. National trends in stage-specific PDAC incidence were analyzed to determine the trends in stage-at-diagnosis over time. Methods: A retrospective cohort study was conducted using the NCI’s SEER database. Patients aged 15-84 years old diagnosed with PDAC between 2004 and 2022 were included. Age-adjusted incidence and mortality rates were calculated per 100,000 people. Trends were assessed using Joinpoint regression to estimate annual percent change (APC). Multivariable Poisson regression was used to estimate incidence rate ratios (IRRs) adjusting for age, sex, race/ethnicity, stage, and calendar year. Results: Between 2004 and 2022 the incidence of localized PDAC was 0.97 per 100,000 versus 1.33 for regional and 5.62 for distant disease. In stage-stratified models, incidence of localized PDAC increased 5% annually, compared with only a 1% increase for both regional and distant stages. Notably, from 2015 to 2022 the APC of localized PDAC was 10.2%. Further stratification by age, sex, and race demonstrated stage-consistent results including a rising with age, lower risk in females, and disparities by race (Black > White; Hispanic, AI/AN, and Asian/PI < White). APC plots confirmed this positive trend towards localized PDAC diagnosis across all subgroups. Conclusions: There has been clear improvement in the ability to diagnose PDAC earlier. While most patients are still diagnosed with distant disease, the increasing rate of localized PDAC diagnoses likely reflect multiple factors. Widespread use of high-resolution CT and MRI has led to more incidental detection of asymptomatic PDAC. The roll out of high-risk surveillance programs targeting individuals with familial or genetic predispositions have enabled earlier diagnosis and improved outcomes. Endoscopic ultrasound (EUS) has improved the ability to detect small or cystic lesions. Liquid biopsy has also begun to demonstrate promise as a non-invasive way to detect early PDAC. These factors, along with heightened clinical awareness, have resulted in a measurable stage shift. These findings support continued investment in early detection strategies to ultimately improve survival. PDAC Incidence trends and annual percent change by stage (2004 – 2022). Stage at Diagnosis Incidence* Incidence Rate Ratio (IRR)* Annual Percent Change (APC)* Localized 0.97 1.05 (1.05-1.06) 5.71 (p < 0.001) Regional 1.33 1.01 (1.00-1.01) 1.83 (p = 0.039) Distant 5.62 1.01 (1.01-1.01) 0.91 (p < 0.001) *95% CI; per 100k people.