Pancreatic cancer, which originates in the glandular cells of the pancreas, is overwhelmingly considered a disease of older age. While extremely uncommon, young people can definitively get pancreatic cancer. Although the disease is most frequently discussed in the context of an older demographic, a small but growing number of cases are now being diagnosed in younger adults.
Prevalence and Age Demographics
Pancreatic cancer is strongly correlated with age, with the median age of diagnosis typically falling around 70 to 72 years old. Approximately two-thirds of cases occur in individuals aged 65 or older. Only a small fraction of pancreatic cancers, less than 3%, are diagnosed in people under the age of 45, highlighting the disease’s rarity in this demographic.
The overall incidence rate is drastically lower for younger people. For instance, the age-adjusted incidence rate for those under 40 is about 0.4 cases per 100,000, compared to 31.1 cases per 100,000 for those 40 and older.
Despite the low absolute numbers, the rate of diagnosis in younger adults, often termed early-onset pancreatic cancer, has been rising faster than in older adults in recent years. Analyses of U.S. data show that between 2001 and 2018, the incidence for people younger than 55 increased at a greater annual rate than for those over 55.
This increase is particularly notable among women aged 15 to 34, who have shown a significantly greater relative increase in incidence rates compared to men in the same age bracket. This shift suggests that factors beyond the typical, long-term lifestyle risks associated with older age may be influencing the disease’s development in younger populations. The trend warrants further investigation into environmental or lifestyle factors that could disproportionately affect this younger group.
Unique Risk Factors in Younger Patients
In older adults, pancreatic cancer is often linked to accumulated lifestyle factors like decades of smoking or heavy alcohol use. However, when the disease manifests in younger individuals, the underlying cause is more frequently attributed to inherited genetic factors rather than long-term environmental exposures. These genetic mutations predispose an individual to cancer development at an earlier age, sometimes decades before the typical onset.
Approximately 5 to 10% of all pancreatic cancer cases are considered familial or hereditary, connected to a known genetic syndrome. Several inherited syndromes are associated with an increased risk, including mutations in the BRCA1 and BRCA2 genes. Carriers of the BRCA2 mutation, which is also linked to hereditary breast and ovarian cancer, have a significantly increased lifetime risk of developing pancreatic cancer.
Other genetic conditions linked to early-onset pancreatic cancer include:
- Peutz-Jeghers Syndrome, caused by a mutation in the STK11 gene, which confers one of the highest risks for the disease.
- Lynch Syndrome, associated with mutations in DNA mismatch repair genes.
- Familial Atypical Multiple Mole Melanoma (FAMMM), caused by mutations in the CDKN2A gene.
- Hereditary pancreatitis, a rare condition that usually begins before age 20 and causes chronic inflammation that substantially raises the lifetime risk for pancreatic cancer.
Recognizing Symptoms in Younger Adults
Pancreatic cancer does not typically produce specific symptoms in its early stages. When symptoms do appear, they are often vague, making diagnosis challenging in young, otherwise healthy people. Clinicians may have a low suspicion for such a rare disease in a young adult, leading to potential diagnostic delays.
Common physical manifestations include unexplained weight loss and new-onset diabetes, especially if the patient is not overweight or lacks a family history. Abdominal or back pain is a frequent symptom, caused by the tumor pressing on surrounding nerves or organs. This pain may be dull and persistent, sometimes worsening after eating.
Jaundice, a yellowing of the skin and eyes, results from a tumor blocking the bile duct. Jaundice can also cause related symptoms like dark urine, light-colored stools, and generalized itching. Any persistent, non-specific gastrointestinal or back discomfort, particularly when accompanied by unintended weight loss, should prompt a thorough medical evaluation, even in younger individuals.
Distinct Cancer Types in Youth
The most common form of the disease, Pancreatic Ductal Adenocarcinoma (PDAC), originates in the ducts and accounts for about 90% of all cases. However, younger patients are sometimes diagnosed with tumor types that are biologically different from the typical PDAC seen in older adults.
Pancreatic Neuroendocrine Tumors (PNETs) are a distinct category that arises from the hormone-producing islet cells of the pancreas. PNETs are rare, making up less than 5% of all pancreatic neoplasms, but they represent a higher proportion of cases in younger patients. These tumors often grow more slowly and may carry a better prognosis than the aggressive PDAC.
A small number of PNETs are linked to genetic syndromes like Multiple Endocrine Neoplasia Type 1 (MEN1). Another extremely rare type sometimes seen in adolescents and young women is the Solid Pseudopapillary Neoplasm (SPN). Recognizing these distinct tumor types is important because they have different behaviors, treatment options, and prognoses compared to the exocrine PDAC that predominates in older age groups.