Geographic distribution of pancreaticobiliary malignancy in central South Africa presenting to the Universitas Academic Hospital Complex

Background: There is limited data on the epidemiology, determination of risk factors and geographical variation of pancreatic cancer in South Africa. The aim of this study is to describe these parameters within central South Africa and compare to national and international reports. Methods: A retrospective review of all patients with newly diagnosed pancreatic cancer on clinical and radiological grounds admitted to Universitas Academic Hospital from 1st January 2015 to 31st December 2019 was performed. Patients were grouped into geographical regions based on their district municipality to identify clusters of pancreatic cancer. Demographic information and details of family history, diabetes and smoking status, and chronic pancreatitis were recorded and analysed in conjuction with the geographical and census data to provided estimates of disease incidence. Results: The mean age of the the 382 patients with pancreatic cancer in the study period was 62.8 years +/- 11.06. Two hundred and twelve (55.5%) were females. The Frances Baard district in the Northern Cape had the highest estimated rate of 3.5/100 000 and the Thabo Mofutsanyana district the lowest at 1.0/100 000. Of the cohort 132 (34.5%) were active smokers, 71 (18.6%) had diabetes mellitus, four (1%) had a history of chronic pancreatitis and two (0.5%) had a family history of pancreatic cancer. Conclusion: The incidence of pancreatic cancer in central South Africa is higher than that reported nationally with a female gender bias, marked regional variation and lack of a family history. These observations merit further evalualtion in the South African context.