Pancreatic cancer has always been considered a disease of old age – something doctors expected to see in people in their late 60s, 70s and 80s.
But increasingly, the patients sitting in front of them are much younger.
They are in their 40s and even 30s; marathon runners, new parents and newlyweds who, until their diagnosis, appeared perfectly healthy.
And while pancreatic cancer in younger people remains rare, the numbers are moving in the wrong direction.
Rates among under-50s have been rising by almost three percent annually, while the disease is expected to strike an estimated 67,500 Americans this year.
Often the first warning signs are deceptively mundane – low back pain or mild digestive problems easily blamed on stress, work or diet.
By the time the cancer is discovered, many have just months to live.
Now, as scientists race to understand what may be driving the rise, a Daily Mail analysis of federal cancer data has uncovered another striking clue: where you live appears to matter.
Washington DC has the highest rate of pancreatic cancer among all age groups in the country, at 16.6 cases per 100,000 people, followed by Wisconsin, New Jersey, Louisiana and Delaware. At the other end of the scale is Colorado, where the rate is nearly 30 percent lower than in the nation’s capital.
And among the new generation of younger patients under 50, the map shifts. West Virginia has the highest rate among that age group, followed by Iowa, Washington DC, Maine and Indiana.
So what is causing these extraordinary geographical differences – and could they offer clues to why this notoriously deadly cancer is increasingly striking younger people?
The Daily Mail spoke to oncologists at the forefront of pancreatic cancer research to investigate the pattern and uncovered a range of factors that may help explain why some parts of America are being hit far harder than others.
Our analysis examined National Cancer Institute data on pancreatic cancer diagnoses from 2019 to 2023, across the population as a whole and specifically among Americans under 50.
While pancreatic cancer remains rare in younger adults, the rise has been striking. From 2000 to 2021, diagnoses increased by 4.3 percent among Americans aged 15 to 34, and by 1.5 percent among those aged 35 to 54.
‘We’re noticing strange things,’ Dr Avo Artinyan, an oncologic and colorectal surgeon in Los Angeles, told the Daily Mail: ‘Patients are definitely getting younger.’
Ryan Dwars, a father of two from Iowa, was diagnosed with stage four pancreatic cancer at just 36 after suffering a persistent pain running down his left side and into his chest
Among Americans of all ages, perhaps the most surprising finding was Washington DC.
The nation’s capital topped the table despite having significantly lower rates of smoking, diabetes and obesity – all established risk factors for pancreatic cancer – than the country as a whole.
‘It’s surprising,’ said Dr Tracy Proverbs-Singh, a gastrointestinal medical oncologist at Hackensack University Medical Center in New Jersey.
‘I think the diversity of the population, the diversity of socioeconomic status, the diversity of race and ethnicity, could be at play.’
About 42 percent of Washington DC residents are black – roughly three times the national average.
National Cancer Institute figures show black Americans are 50 to 90 percent more likely to develop pancreatic cancer than their white peers.
There are also stark inequalities within the capital. About 4.3 percent of black residents are uninsured, nearly twice the rate among white residents, while the poverty rate among black residents is 30.5 percent, compared with five percent among white residents.
‘Demographics do make a huge difference,’ Artinyan said.
Another possible factor is alcohol.
Washington DC has long had one of the highest levels of alcohol consumption in the country, with residents drinking around four gallons per capita – rivaled only by New Hampshire and Delaware.
When the body breaks down alcohol, it produces acetaldehyde, a known carcinogen that can damage DNA. Heavy, long-term drinking can also cause pancreatitis – chronic inflammation of the pancreas – which itself increases the risk of pancreatic cancer.
A 2025 study led by the International Agency for Research on Cancer found that every additional 10g of alcohol consumed per day – roughly a small glass of wine or half a pint of beer – was associated with a three percent increased risk of pancreatic cancer.
‘Alcohol is a carcinogen,’ said Proverbs-Singh. ‘We know chronic and significant alcohol use can lead to inflammation, or pancreatitis. Pancreatitis directly increases the risk of pancreatic cancer.’
Alcohol may also help explain Wisconsin’s position as the state with the second-highest rate, at 15.3 cases per 100,000.
Nearly a quarter of residents report binge drinking, among the highest rates in America, while 64 percent consume alcohol at least once a month.
Apple founder Steve Jobs (seen above in 2007) was diagnosed with pancreatic cancer in 2003 and died in 2011 at age 56
Patrick Swayze, pictured above, battled pancreatic cancer for 20 months before dying in 2009
But Wisconsin also has an older-than-average population, with 20 percent of its residents 65 or older, compared with 18 percent nationally. Of the state’s counties, 17 percent have a median age above 50.
Older age is one of the strongest risk factors for pancreatic cancer, as DNA damage and environmental exposures accumulate over a lifetime.
Proverbs-Singh said: ‘The older a patient gets, the higher risk they have of all cancers.’
Colorado, at the opposite end of the table, provides an intriguing contrast.
It has the lowest pancreatic cancer incidence, at 11.9 cases per 100,000, as well as the lowest obesity rate in the country, at 25 percent. It also has the lowest rate of physical inactivity, at 17.7 percent.
‘It’s a bit healthier of a population,’ Proverbs-Singh said.
Among younger Americans, West Virginia stands out.
It had the highest incidence among under-50s, at 2.1 cases per 100,000 – and here obesity and diabetes stand out as possible explanations.
About 41 percent of residents are obese and 15 percent have diabetes, both established risk factors for pancreatic cancer.
The American Cancer Society estimates that people with obesity have about a 20 percent greater risk of developing pancreatic cancer than those at a healthy weight.
Scientists believe one reason is that excess visceral fat, which surrounds the abdomen and vital organs, causes chronic, low-grade inflammation that can damage cells and promote cancer-causing mutations.
Obesity also makes the body’s cells resistant to insulin, forcing the pancreas to produce increasing amounts of the hormone.
Research suggests these persistently high insulin levels may themselves damage the pancreas.
In one landmark study, researchers at the University of British Columbia found that excess insulin caused pancreatic cells in mice to churn out unusually large amounts of digestive enzymes.
Some became activated prematurely, damaging the pancreas and causing inflammation.
In mice carrying mutations in the KRAS gene – found in more than 90 percent of human pancreatic cancers – this inflammatory environment helped precancerous cells develop.
‘The link with diabetes and pancreatic cancer is probably linked to having prolonged high insulin,’ Proverbs-Singh said. ‘That’s even a precursor for true diabetes, so you don’t even have to have diabetes.’
The above chart shows the survival rate of pancreatic cancer by stage
Longtime Jeopardy host Alex Trebek (pictured above) died from pancreatic cancer in 2020 at age 80
Holly Shawyer from North Carolina was diagnosed with pancreatic cancer at 34, despite being a marathon runner. Her main symptom was a stomachache
But obesity and diabetes cannot explain the entire geographical pattern.
Iowa, which has the second-highest pancreatic cancer rate among under-50s, at 1.7 per 100,000, also has high levels of obesity. However, researchers are investigating another possible risk factor there: pesticides.
An estimated 85 to 90 percent of Iowa’s land is farmed or ranched, and pesticide use is particularly heavy across many of its rural counties.
Research suggests some pesticides can damage DNA directly and promote inflammation in the pancreas. They have also been linked to the accumulation of fat around the organ, which in turn can increase the risk of insulin resistance and diabetes.
One recent study of pesticide applicators in Iowa and North Carolina found a threefold increased risk of pancreatic cancer associated with the herbicide pendimethalin. Another, from the Mayo Clinic, found regular occupational pesticide exposure was associated with a 20 percent increased risk.
Indiana, which also appears among the five states with the highest rates in under-50s, is another major corn and soybean producer with high levels of pesticide use.
‘Most pesticides are direct carcinogens,’ Proverbs-Singh said. ‘Inflammation probably plays a role, but these are probably just directly carcinogenic.’
But then there is Maine.
The state has the same 1.6-per-100,000 incidence among under-50s as Indiana, yet significantly lower rates of obesity, diabetes and pesticide use.
One possible clue is environmental exposure.
More than half of Maine residents rely on private groundwater, compared with about 15 percent of Americans nationwide, and around one in ten private wells contains arsenic above the Environmental Protection Agency (EPA) limit.
Inorganic arsenic can generate unstable molecules in the body that damage cell membranes, proteins and DNA, potentially increasing the risk of cancer-causing mutations.
Radon has also raised concern. Around one in three Maine homes tests above the EPA’s recommended action level, compared with about seven percent nationwide.
The gas is an established cause of lung cancer, although evidence linking it to pancreatic cancer remains unclear.
‘It would require study in that particular area and of those people to parse that out,’ Proverbs-Singh said. ‘But I do think environmental factors like this play a role, especially in younger patients.’
Ultimately, none of these geographical patterns can prove why an individual develops pancreatic cancer – and for many patients without a family history, the answer may never be known.
But Proverbs-Singh said the findings reinforce the importance of tackling the risks people can control.
‘The alarming fact is that pancreatic cancer is rising uniformly across the country,’ she said.
She recommends maintaining a healthy weight, exercising regularly and limiting ultra-processed foods, instead favoring a Mediterranean-style diet rich in whole grains, fish, nuts, berries and healthy fats.
She also urges anyone experiencing warning signs such as unexplained weight loss, persistent back pain, floating stools or suddenly developing difficult-to-control diabetes to see a doctor.
