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5 States Where Pancreatic Cancer Prevalence Is the Highest

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There is no making light of the fact that cancer is a terrible disease, claiming more lives in the U.S. each year save for heart disease. What's even scarier is that cancer prevalence is rising in the U.S., whereas a number of other leading causes of death are shrinking because of improved awareness and better pharmacologic solutions.

If there are positives to come out of this, it's that improved awareness of cancer risk factors has helped some people alter their lifestyle habits in an effort to lower their risk of getting cancer in the first place. In addition, we've learned that some cancers are actually quite beatable with early detection. In other words, a cancer diagnosis isn't necessarily a death sentence as many people once feared it was.

Source: Bill Branson, Wikimedia Commons.

However, not all cancers are created equally -- and perhaps none is more rightfully feared than a pancreatic cancer diagnosis. When examining the 12 most-diagnosed cancers last year, pancreatic cancer ranked 12th in diagnosing prevalence, with 45,220 cases estimated to be reported in 2013, but it ranked extremely high in total male and female cancer deaths, according to the American Cancer Society. In fact, overall five-year pancreatic cancer survival rates have improved from just a paltry 2% in 1975-1977 to 6% in 2002-2008 -- and as I noted in May, this had more to do with risk factor awareness than major pharmacologic improvements.

Five states with the highest prevalence of pancreatic cancer
Today, I want to look at what five states are exhibiting the highest prevalence of pancreatic cancer cases, as well as examine some of the revolutionary treatments that are working their way through the pipeline to treat this difficult type of cancer.

Here are the five states that, according to the Centers for Disease Control and Prevention, are currently boasting the highest incident rate of pancreatic cancer: 


Age-Adjusted Incidence Rate



New York








Source: Centers for Disease Control and Prevention, rates per 100,000 people for men and women, based on 2010 data.

To add some context to these figures, the national average incidence rate of pancreatic cancer is just shy of 12 cases per 100,000 men and women, with the nation's lowest reading coming from Wyoming at 6.6 cases per 100,000 people.

What's particularly disappointing about pancreatic cancer is that surgical resection -- which is often difficult given that the cancer is often discovered in an advanced stage -- is rarely successful in curing pancreatic cancer. Relapses of the cancer and metastases are unfortunately quite common. As you can see below, median overall survival based on diagnoses is generally poor.

Source: American Cancer Society; data from Bilmoria.

Perhaps one of the most obvious reasons that Hawaii, New York, Connecticut, and Maine lead this list is that they're somewhat common retirement locations. Getting older is one of, if not the, biggest risk associated with pancreatic cancer risk. A number of hypotheses exist as to why this occurs, but generally speaking it's believed that a number of toxins accumulate as we age and may be involved in spurring cancer development when we get older.

As should come as no surprise, smoking is another contributing factor to pancreatic cancer. In this case, though, smoking doesn't appear to be the primary factor leading to an increase in these Northeastern U.S. states (with the exception being Hawaii). Not one of these states ranks among the top 10 in terms of percentage of smokers. 

Perhaps a better explanation, and one we explored last week, would be trace elements of carcinogens being found in the soil and water supply in the Northeast or Appalachian region, including arsenic, cadmium, and nickel. The reason I bring this up is that there's once again (with the exception of HawaiI) a west of the Mississippi River bias in the concentration of pancreatic cancer cases. Excluding Hawaii, and adding Louisiana into the equation, 11 of the top 12 states in terms of pancreatic cancer rates are located in the Eastern half of the country.

Source: Centers for Disease Control and Prevention; incidence rates per 100,000 people.

How we're currently treating pancreatic cancer
I certainly don't want to make it seem like biopharmaceutical companies have sat on their hands when it comes to treating pancreatic cancer over the past four decades, but treatment improvements have been few and far between.

The two primary therapies given to treat advanced pancreatic cancer are Pfizer's (NYSE: PFE  ) Sutent and Novartis' Afinitor. Sutent practically doubled the progression-free survival of the placebo it was tested against at 10.2 months versus 5.4 months, however no complete responses were observed in its clinical studies. For Afinitor, progression-free survival checked in at a very comparable 11 months compared to just 4.6 months for the placebo.

Another therapy occasionally given to patients is combination drug folfirinox which has been shown to be effective on a number of difficult-to-treat cancers, but is also very toxic, meaning few patients last very long on the therapy.

Finally, Celgene's (NASDAQ: CELG  ) Abraxane was recently approved to treat advanced pancreatic cancer in combination with Eli Lilly's Gemzar. Although the risk of death was reduced by 28% by the addition of Abraxane, and PFS improved 1.8 months, only 9% of patients were still alive just two years following initial dosing.

This isn't to say that other biopharmaceutical companies haven't tried to develop new pancreatic cancer therapies. Clovis Oncology retired its mid-stage therapy CO-101 in late 2012 after the drug failed to provide a statistical benefit over Gemzar which is another prescribed therapy. Also, just this past December, Onconova Therapeutics saw its share price tank after its leading drug prospect, rigosertib, when given in conjunction with Gemzar, failed to improve median overall survival. It's not as if these companies aren't trying, but pancreatic cancer is a difficult disease to treat.

New ways of treating pancreatic cancer
While far from a sure thing, there are three unique ways that researchers are now attempting to fight pancreatic cancer that are working their way through clinical trials.

The first, as we've looked at recently, are cancer immunotherapies which work by retraining the body's immune system to recognize and attack currently suppressed cancer cells. One company leading this charge is NewLink Genetics (NASDAQ: NLNK  ) .

NewLink's experimental therapy, algenpantucel-L, works by encouraging modified cancer cell lines to express alpha-gal, which is a carbohydrate that the human body has a natural immunity to. The body's immune system begins to recognize this carbohydrate and to attacks cells (in this case cancer cells) that express alpha-gal. Currently, NewLink is enrolling patients for its phase 3 studies in pancreatic cancer which, in phase 2 studies, showed an impressive 62% disease-free survival rate in its resected pancreatic cancer study after one year -- a notable improvement considering the high relapse rate.

Another unique way of attacking pancreatic cancer is by focusing on cancer stem cells rather than on cancerous cell growth. These stem cells are often immune to chemotherapy treatment and they could be the origin for relapses and metastases, so their eradication could make a big difference in resectable cases of pancreatic cancer.

The company working this angle is OncoMed Pharmaceuticals (NASDAQ: OMED  ) , which in December signed a mammoth collaborative deal with Celgene. Currently in the early phases of treatment, OMP-59R5 is being tested as an anti-cancer agent in advanced pancreatic cancer as well as non-small cell lung cancer. In addition to blocking cancer cell differentiation, OMP-59R5 is believed to also suppress blood vessel growth, which is crucial to solid tumor development.

Last, but certainly not least, we have Threshold Pharmaceuticals (NASDAQ: THLD  ) which is attempting to treat pancreatic cancer, and a number of other cancer types, via tumor hypoxia. The idea behind Threshold's therapies is that solid tumor growth tends to be willy-nilly, for lack of a better phase, and that out-of-control growth rate can lead to areas of the tumor that outpace blood vessel growth. These low-oxygen, or hypoxic, regions of the tumor are perfect targets for Threshold's lead drug, TH-302, since hypoxic cells are a rarity among healthy cells.

Currently, Threshold has an ongoing phase 3 trial known as MAESTRO, which is planning to enroll up to 660 pancreatic cancer patients. In phase 2 studies TH-302 delivered a 41% reduction of risk for disease progression and represented a 2.4 month median PFS improvement over the control arm.

Clearly there's still a long way to go with regard to improving treatment options, but we appear to be headed in the right direction.

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Read/Post Comments (36) | Recommend This Article (27)

Comments from our Foolish Readers

Help us keep this a respectfully Foolish area! This is a place for our readers to discuss, debate, and learn more about the Foolish investing topic you read about above. Help us keep it clean and safe. If you believe a comment is abusive or otherwise violates our Fool's Rules, please report it via the Report this Comment Report this Comment icon found on every comment.

  • Report this Comment On March 01, 2014, at 12:54 PM, tomcorar1 wrote:

    Co-relation is easy: they're all Democrat states! Seriously, I lost my mother and uncle to pancreatic cancer and they lived only a few months after diagnosis. Here's hoping they soon figure this one out.

  • Report this Comment On March 01, 2014, at 1:23 PM, jbranden6280 wrote:

    Is this an article about PANCREATIC cancer or about PROSTATE cancer? I found several instances in the article where PROSTATE cancer is mentioned. Please correct errors.

  • Report this Comment On March 01, 2014, at 1:37 PM, Lespauldude wrote:

    Awesome job of editing content:

    "What's particularly disappointing about prostate cancer is that surgical resection -- which is often difficult given that the cancer is often discovered in an advanced stage -- is rarely successful in curing pancreatic cancer" - PROSTATE cancer???

  • Report this Comment On March 01, 2014, at 1:52 PM, TMFUltraLong wrote:


    I only see the one error where I meant to put pancreatic cancer instead of prostrate cancer under how we're currently treating pancreatic cancer. I've asked my editor for the quick fix. The other mentions are as a comparison of prostate vs. pancreatic cancer.


  • Report this Comment On March 01, 2014, at 1:56 PM, smurf47 wrote:

    Pancreatic killed my loved one. It was diagnosed after 3 months of tests. Jack Andraka, a young scholar discovered a blood test to identify people with pancreatic cancer cells. What company/ research facility will take up the gauntlet this young man has thrown down and make this test a mainstay in the US medical physicals for everyone over 50 the way chloresterol, PSA, and other blood tests are given. This is the way pancreatic cancer can improve the survival rate. It would certainly be the cheapest.

    And as with all cancers, early detection is the absolute best way too beat this disease.

  • Report this Comment On March 01, 2014, at 2:59 PM, doris2332 wrote:

    I am surprised you didn't mention alcohol which is lethal for the pancreas in large doses. Most people that die from pancreatic cancer are alcoholics or binge drinkers what ever you want to call them. The states you mention are states where folks drink a lot of alcohol...smoking hardly ever and maybe even never causes pancreatic cancer....I don't know if a lot of nitrites in foods can cause pancreatic cancer, it certainly causes cancer.

    Doris R.N. Ret.

  • Report this Comment On March 01, 2014, at 3:10 PM, SpottedDick wrote:

    No mention of Spam? Nitrates are a risk factor in Pancreatic cancer.

  • Report this Comment On March 01, 2014, at 5:06 PM, 1BIOTECH wrote:

    How do you have an article on Pancreatic treatments under development and not mention NVLX, Nuvilex. The most promising treatment out there? Why are people trying to hide the fact that this technology can be a real game changer for the treatment of all P>C phases. Must not have done your homework.

  • Report this Comment On March 01, 2014, at 5:11 PM, ardoucette wrote:

    If you go to the CDC site you will find out that BLACKS have nearly double the incidence rate for Pancreatic cancer.

    Their population is skewed to the East of the Mississippi.

  • Report this Comment On March 01, 2014, at 5:18 PM, Petronilus wrote:

    Some toxins we get in our body accumulates and can lead to cancer.

    For example, your amalgam fillings might be your worst enemy and in a worst-case might be in a mode of galvanic decay releasing high doses of mercury and mercury containing chemicals into your body. Some day after years of exposure, the effect can become a tumor or early dementia.

    Mercury is ages ago banned from your television but not from your own mouth where it sits there and evaporates or corrodes into the tissue and saliva. Unfortunately most of the dental profession is in denial about the fundamental chemistry involved and the health hazards. We have better rules on disposing used mercury containing dental fillings than rules on how they are dealt with in your own body.

  • Report this Comment On March 01, 2014, at 5:28 PM, 1BIOTECH wrote:

    Nuvilex’s pancreatic cancer treatment consists of the use of a proprietary cellulose-based live-cell encapsulation technology together with the long-known and widely used anticancer drug ifosfamide (IFEX®). Ifosfamide is a prodrug that must be activated to its cancer-killing form for it to be effective; this usually occurs in the liver. pancreatic-trial Ifosfamide is administered intravenously (systemically), and like all anticancer drugs given this way, can cause drug-related toxicities in organs of the body unrelated to the tumor itself. The 22P1G cells encapsulated are capable of converting ifosfamide into its cancer killing form. The cells contain high levels of activity of one of the components of the cytochrome P450 enzyme system known as CYP2B1. The cytochrome P450 enzyme system is found in the liver and is responsible for the metabolism of lipids, steroid hormones, drugs, and other toxic substances. In actual practice, the pancreatic cancer treatment consists of first implanting the capsules containing the ifosfamide-activating cells through the use of radiography and then giving ifosfamide by its usual route of administration

  • Report this Comment On March 01, 2014, at 5:32 PM, 1BIOTECH wrote:

    Should have mentioned Nuvilex I agree, This is a game changer. Not sure why it's not top of the list.

  • Report this Comment On March 01, 2014, at 5:49 PM, joneshank11 wrote:

    The main focus of the article is to discuss the companies that have medicines to use in the treatment of pancreatic cancer. Most meds fail at this endeavor.

    The article does not fulfill its supposed promise of educating the reader about the issues in the 5 states that actually cause the cancer. The actual cause for this type of cancer in these 5 states is coal burning. All of the elements listed in the article are by-products of burning coal for energy.

    Therefore, if you really want to stop the cancer, stop burning toxic coal.

  • Report this Comment On March 01, 2014, at 7:28 PM, clutch58 wrote:

    WV is coal country. NY is not. Explain the higher incidences in NY.

  • Report this Comment On March 01, 2014, at 7:39 PM, Lespauldude wrote:

    Doris2332 - When did you retire - 1956? Smoking is a VERY big risk factor for PC. The following is from John Hopkins Medicine web site:

    "Cigarette smoke contains a large number of carcinogens (cancer causing chemicals). Therefore, it is not surprising that cigarette smoking is one of the biggest risk factors for developing pancreatic cancer. For example, smoking during college has been associated with a 2-3 fold increased risk of pancreatic cancer. "

    "Most people that die from pancreatic cancer are alcoholics or binge drinkers " - that is also wrong. There are MANY people who do NOT drink alcohol excessively and contract PC.

  • Report this Comment On March 01, 2014, at 9:04 PM, TMFUltraLong wrote:


    Nuvilex doesn't meet the tickering requirements to be discussed... It's a penny stock traded on the over-the-counter market, and we don't discuss OTC penny stocks at The Fool.


  • Report this Comment On March 01, 2014, at 9:46 PM, nancyj06460 wrote:

    This article speaks to "pancreatic cancer" as if it is a singular disease. It does not discern between adenocarcinoma of the pancreas and neuroendocrine cancer (PNETs). That being said, the information provided is not offered in an appropriate perspective. Each of these types of cancers have different therapies depending on the histology of the tumor present in the pancreas.

    Nancy T. MSN, RN

  • Report this Comment On March 01, 2014, at 10:34 PM, desuhu wrote:

    We just lost a young woman, 53, in our community to pancreatic cancer this week and she neither smoked nor drank excessively. She was diagnosed at the beginning of August and died last Wed., Feb. 26th. Sad indeed.

  • Report this Comment On March 02, 2014, at 12:15 AM, bchick wrote:

    My Dad had the Whipple for surgical resection of the tumor and lived for 9 more years. The cancer didn't return but he couldn't absorb nutrients from his food as a long term effect of the invasive surgery. The "plumbing" starts to leak inside and the second surgery to repair left him unable to be closed and in intensive care on breathing machine for 5 months. Those 9 years were precious to us and he was not a drinker--business owner and very active.

  • Report this Comment On March 02, 2014, at 5:00 AM, 145khoury wrote:

    .ummm... you mentioned these are states people generally retire? What are you talking about? NOBODY retires TO Connecticut (WAY too many taxes including social security, cold weather...etc), NY same as CT but worse...), Pennsylvania (same as CT + NY...) VERY few can fully retire to Hawaii for its #1 WORST cost of living of all 50 states....

  • Report this Comment On March 02, 2014, at 8:51 AM, FreddyWalker wrote:

    Nice article to which I'd like to add Oncolytics Biotech (Oncy) which has two pancreatic cancer trials ongoing with their reovirus drug Reolysin. A single arm PH II in combination with Gemcitibine and a randomized PH II in combination with Paclitaxal and Carboplatin. The data readouts for both should be happenning soon. Dr. Tanios Bekaii-Saab who has worked on both trials and is the PI for the randomized trial works at the Ohio State University's Wexner Medical Center. He is very high on the efficacy of Reolysin and has said "This virus is likely to be the next standard of care in pancreas cancer" . You can read this very recent article by goog'ling "Trial Uses Common Cold To Fight Pancreatic Cancer". Anecdotally you can also goog "Mayor Brennan Bexley Ohio" and read articles about his treatment in the randomized Reolysin trial. He survived a year after stage IV diagnosis with PC. He was originally randomized to the placebo group of the randomized Reolysin trial, was failing badly and then was switched to the test group and showed some dramatic recovery (he was able to re-run for mayor and won) before finally succumbing at about one year after diagnosis a few monts after being re-elected.

    Disclosure: I own shares of Oncolytics Biotech.

  • Report this Comment On March 02, 2014, at 9:39 AM, jazznut50 wrote:

    This article and the entire medical-establishment cancer-treatment industry is a joke. They cure NO ONE! The best they do is delay death with their burn, slash and poison agenda.

    One of the few doctors actually CURING cancer, and even Stage IV pancreatic cancer, is Dr. Nicholas Gonzalez in New York City. And the ONLY doctors CURING cancer are alternative-therapy doctors. The only thing the medical-mafia "cures" is filling the pockets of big pharmaceutical companies.

    Anyone who takes the advice of the medical establishment on cancer treatment is a dead duck, and it's not a question of "if", it's only a question of "when".

  • Report this Comment On March 02, 2014, at 1:18 PM, TYPEONEGATIVE wrote:

    "Perhaps one of the most obvious reasons that Hawaii, New York, Connecticut, and Maine lead this list is that they're somewhat common retirement locations"

    If that was the case, Florida would be number 1 with a bullet

  • Report this Comment On March 02, 2014, at 1:21 PM, TYPEONEGATIVE wrote:

    "One of the few doctors actually CURING cancer, and even Stage IV pancreatic cancer, is Dr. Nicholas Gonzalez in New York City. And the ONLY doctors CURING cancer are alternative-therapy doctors. The only thing the medical-mafia "cures" is filling the pockets of big pharmaceutical companies."

    jazznut50 , please shut the hell up.

    I'm so sick of getting a quack on every article related to cancer.

    My mother was cured (yes, the Doctor said the word, he is one of the top rated in the country). This conspiracy crap is a joke, a dead patient doesn't make them money, they want to keep you alive. Stop the New World Order crap, stop the carrot juice colon blow garbage, get off the conspiracy train. Many cancer death rates have fallen significantly in the last 20 years, Lymphoma being a big one.

  • Report this Comment On March 02, 2014, at 2:46 PM, CBG wrote:

    I lost a loved one to pancreatic cancer. He was a heavy drinker, did illegal drugs, and smoked for many years. It is my understanding that all of this kind of behavior when done while someone is young ultimately catches up with them in their later years, especially men. My mom called it "burning the candle at both ends".

    Years later a dear colleague I worked with came down with PC. When first diagnosed, he took a round of chemo but it made him so ill he decided to go the alternate way. He did some research on herbs and other alternate methods. His research led him to a well known herb that stops PC. He also juiced organic veggies and exercised. His allopathic doctors were completely mystified about his miraculous recovery, but he refused to tell them what he was doing. I saw him a few years ago and he was still in remission, looked great, and was doing just fine.

  • Report this Comment On March 02, 2014, at 2:47 PM, kdavis860 wrote:

    I'm sick of quack comments too...

    The state-vs.-state differences weren't very interesting, but the part about experimental treatments was.

    The crazy alternative people already got permission to sell just any garbage with the disclaimer "These statements have not been evaluated by the FDA... " which I read to mean "We're lying, but here's the lie... "

    I hope they never get any more than that. There are those who would like to return to the days of snake oil salesmen.

  • Report this Comment On March 02, 2014, at 4:59 PM, cspd4it wrote:

    My husband died of cancer. They could not determine if it was pancreatic or liver cancer. If they can't determine where the primary site is or origin this report is meaningless. That means other states could be higher.

  • Report this Comment On March 02, 2014, at 6:16 PM, Corsair3117 wrote:

    I just have to second the fact that Connecticut and NY are decidedly NOT magnets for retirees due to high taxes (an economic factor many Fool columnists are loath to see as a negative to economic growth or perserving individuals' assets despite the iron-clad evidence) and Hawaii is out of most retirees' reach. Arizona and Florida have many retirees-most of the latter coming from NY.

  • Report this Comment On March 02, 2014, at 8:34 PM, algy wrote:

    my father has pancreatic cancer and its at stage 4 can anyone out there guide me the right way to help him to live longer he lives in houston texas thank you

  • Report this Comment On March 02, 2014, at 10:03 PM, sasRN20 wrote:

    We give ifosfamide at my work for PC as well as head/neck, NHL and a couple other cancers. It's usually given with Mesna to prevent hemorrhagic cystitis. BTW I thought retirees went to FL and AZ.

  • Report this Comment On March 03, 2014, at 12:33 AM, Tony1076 wrote:

    Love to see other nuvilex people on here!! It's great if it wasn't for seeking alphas hit job on Friday things would be great!! I do understand the OTC requirements, but glad to see the nuvilex army growing and spreading the word! GAME CHANGER!!!!

    PS seeking alpha is dead to me!! Sorry to bring up another stock analyzer blog? Newsletter? Love the fool!! Whatever it is

  • Report this Comment On March 03, 2014, at 12:36 AM, Tony1076 wrote:

    Sean.... You've heard of nuvilex? Did they come up in your research? Confidentially what did you think? Just between you and the board lol

  • Report this Comment On March 03, 2014, at 1:32 AM, Tony1076 wrote:

    Sean? Did you come across nuvilex in your research? What did you think?

  • Report this Comment On March 03, 2014, at 1:33 AM, Tony1076 wrote:

    Oops twice

  • Report this Comment On March 03, 2014, at 1:47 AM, Krfool1 wrote:


    My dad passed away from PC , the many specialists I've asked say that PC spreads to the liver but liver cancer does not cross into the panc.

    My dad did smoke and drink.

    All, PC can also be a result of having the bracca ( sp) gene, just like breast and ovarian cancers. If you have had multiple family members with one of these cancers, you should do some genetic testing, although it's really expensive.

    There has not been a new surgery for PC in over 50 years...hope they find a treatment soon.

  • Report this Comment On May 16, 2014, at 12:58 PM, LaureyWilliams wrote:

    It's hard for me to understand the differences between all the different types of cancers. Are there certain things that can cause each cancer individually? Or are they all pretty much caused by the same things.

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Sean Williams

A Fool since 2010, and a graduate from UC San Diego with a B.A. in Economics, Sean specializes in the healthcare sector and in investment planning topics. You'll usually find him writing about Obamacare, marijuana, developing drugs, diagnostics, and medical devices, Social Security, taxes, or any number of other macroeconomic issues.

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