Evolving burden of pancreatic cancer in the Middle East and North Africa Region, 1990–2023: an analysis based on the Global Burden of Disease Study 2023

Introduction

Pancreatic cancer remains one of the most lethal malignancies globally, characterized by aggressive biological behavior and a prognosis that has seen marginal improvement compared to other cancers (1). While the global burden is well-documented, the Middle East and North Africa (MENA) region represents a critical focal point for studying cancer inequities. The region’s epidemiological landscape is defined by a unique intersection of rapid economic development and profound diagnostic gaps. Unlike more stable high-income regions, MENA countries exhibit extreme heterogeneity in oncology infrastructure, ranging from world-class specialized centers to systems fractured by economic instability and lack of basic screening protocols (2,3). Understanding this region is essential from a public health perspective because it serves as a microcosm of the “metabolic explosion” seen in transitioning economies, where the rapid adoption of Westernized lifestyles outpaces the development of healthcare systems capable of managing complex, high-fatality malignancies like pancreatic cancer.

The period from 1990 to 2023 has been far from static for the MENA region; rather, it has been defined by transformative demographic, economic, and political shifts that have fundamentally altered its disease profile. Accelerated urbanization and globalization have facilitated a rapid nutritional transition, while the region has simultaneously faced repeated episodes of armed conflict and political instability (2). These structural changes have fostered an environment where traditional risk factors are compounded by high tobacco exposure, rising obesity rates, and one of the highest global prevalences of type 2 diabetes (4,5). In conflict-affected areas, the collapse of primary care and diagnostic facilities has likely masked the true incidence of pancreatic cancer, creating a “data vacuum” that complicates regional health planning (6). By analyzing trends since 1990, this study captures how these complex, non-linear social forces have manifested in the rising burden of a disease that requires both advanced diagnostic capacity and long-term metabolic health management.

The current state of the pancreatic cancer crisis is reflected in the prevalence rate. Due to the high lethality of pancreatic cancer, the mortality rate is also high and closely mirrors the incidence rate (7). There is a narrow window for therapeutic intervention in the disease; thus, there is an urgent need to assess how the healthcare systems throughout the MENA region have evolved in response to rising rates of non-communicable diseases. A central challenge in addressing pancreatic cancer in MENA is the stark inequity in oncology infrastructure. High-income Gulf nations have made massive investments in advanced diagnostic imaging and precision oncology, whereas lower-income and conflict-ridden nations struggle with fragmented care pathways and limited access to palliative services (8,9). This disparity in diagnostic capacity means that the “evolving burden” we observe is not merely biological but is also a reflection of uneven healthcare maturation across the region. Consequently, a meaningful public health analysis must move beyond regional averages to investigate how these internal inequities influence mortality and DALYs. By providing a high-resolution geographical representation of this burden, we aim to bridge the data gap in regional oncology and provide a foundation for targeted policies that account for the diverse socioeconomic realities of the MENA region.

The disability-adjusted life years (DALYs) metric also portrays a broader picture of the economic and social costs incurred by the population due to pancreatic cancer beyond survival (10). The majority of the DALY burden for pancreatic cancer is attributable to years of life lost as a result of premature death; as a result, the burdens of pancreatic cancer on the productive portion of the population are devastating (11). This study aims to assess the temporal changes in the burden of pancreatic cancer for the MENA region over the last three decades, providing a high-resolution geographical representation of the burden of pancreatic cancer across the MENA region. Such an analysis is essential for identifying high-risk populations, evaluating the efficacy of regional health policies, and guiding the allocation of resources toward early detection and palliative care. Ultimately, this manuscript serves to bridge the data gap in regional oncology, offering a foundation for targeted interventions in an area of the world where the cancer burden is rapidly evolving. We present this article in accordance with the GATHER reporting checklist (available at https://jgo.amegroups.com/article/view/10.21037/jgo-2026-0539/rc).

Methods

Data source and study design

The current study employed pooled data from the Global Burden of Diseases (GBD) 2023 study for a longitudinal analysis of pancreatic cancer trends in the MENA region from 1990 to 2023. GBD 2023 represents the most recent and stable comprehensive release available at the time of this analysis, with finalized and validated data accessible until 2023. Using this dataset ensures the most up-to-date regional surveillance while maintaining a consistent methodological framework across the 34-year period.

Study setting and regional classification

This study was conducted on the MENA region using the GBD framework definition. The countries in the MENA region were divided into two regional groups in order to conduct a more thorough examination of regional differences. Group 1 includes Turkey, the Levant (Syria, Lebanon, Jordan, and Palestine), and North African countries (Egypt, Libya, Algeria, Tunisia, Morocco, Sudan); while group 2 includes Arabian Peninsula countries (Bahrain, Iran, Iraq, Kuwait, Oman, Qatar, Saudi Arabia, United Arab Emirates) and nearby Western Asian countries (Afghanistan, Yemen). This was done for the purposes of analysis; this should not be confused with the MENA region’s official administrative hierarchy used by the GBD(s).

Measures

The main measures used in this study are: (I) age-standardized rates for pancreatic cancer prevalence; (II) sex-specific age-standardized pancreatic cancer; and (III) age-standardized DALYs; the latter being a combination of years [years of life lost (YLL)] lost due to the effects of cancer and years of living with disability due to cancer (YLD). The prevalence refers to the number of people diagnosed with pancreatic cancer at any time during their lifetime. Mortality measures are the number of people who died from pancreatic cancer. YLL are calculated by multiplying total cancer mortality by the average number of years remaining in their lifetime for males or females at the ages they died. All rates were age-standardized using the GBD world standard population and are presented with 95% uncertainty intervals (UIs). These UIs are critical for interpreting the data, as they reflect the uncertainty inherent in the underlying primary data quality; wider intervals in the 1990s or in conflict-affected nations (e.g., Afghanistan, Yemen) indicate more heavy reliance on the modeling framework and spatiotemporal smoothing due to sparse primary reporting.

Data extraction

The Global Health Data Exchange (GHDx) was consulted for estimates of pancreatic cancer prevalence, mortality and DALYs using the GBD Results Tool and GBD Compare platforms. Data for all available years (1990–2023) were extracted stratified by sex and country. The extraction complied with standards that required all data be de-identified, aggregated to the population level.

GBD modeling framework

The GBD 2023 study utilizes a diverse array of primary data sources tailored to each country’s reporting capacity. For the MENA region, inputs primarily include vital registration (VR) systems, national and sub-national cancer registries, and verbal autopsy data where formal registration is absent. To address the inherent unevenness in data quality and under-ascertainment, the GBD framework employs a rigorous “garbage code” redistribution process, where deaths assigned to non-specific or implausible causes are re-allocated to probable underlying causes like pancreatic cancer based on age-sex-specific algorithms. Mortality estimates are generated using the Cause of Death Ensemble model (CODEm), which runs a wide range of sub-models (e.g., mixed-effects models and spatial-temporal regressions) and weights them based on their predictive validity. This ensemble approach is specifically designed to maintain robust estimates in countries with sparse data by leveraging trends from data-rich neighboring settings. For non-fatal outcomes, DisMod-MR 2.1, a Bayesian meta-regression tool, ensures that prevalence, incidence, and mortality estimates remain internally consistent through a series of differential equations. Spatiotemporal Gaussian Process Regression (ST-GPR) was further utilized to smooth data across time and geography, effectively “filling” data gaps in politically unstable or low-resource settings during the 1990s and early 2000s while accounting for country-level covariates such as the Socio-demographic Index (SDI) (12,13). More detailed methods can be found in other publications (14,15).

Statistical analysis

This study utilizes a comprehensive descriptive and narrative analysis framework to evaluate long-term shifts in the pancreatic cancer burden across 21 MENA countries, sub-regions, and by sex. This analytical approach was intentionally selected to prioritize a high-resolution geographical comparison and to contextualize epidemiological trends within the region’s complex socio-political and economic transitions. While formal trend modeling like Joinpoint regression can pinpoint annual percentage changes, our narrative method facilitates a broader interpretation of the “evolving burden”—identifying significant patterns of growth, stability, and decline while directly addressing the stark inequities in oncology infrastructure and diagnostic capacity across the region. We calculated the total and percentage changes for age-standardized prevalence and DALYs from 1990 to 2023 to quantify the regional trajectory. To ensure statistical reliability, all trends are presented with 95% UIs, which reflect the precision of the underlying GBD modeling framework.

Ethical considerations

The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. Given that this study was based on the publicly accessible aggregated secondary data without any involvement of human subjects’ research, no institutional review board approval was necessary.

Results

Prevalence trends in the epidemiological burden of pancreatic cancer in the MENA region, 1990–2023

As illustrated in Figure 1, according to the GBD 2023 database, the age-standardized prevalence of pancreatic cancer in the MENA region showed a considerable and near-linear increase during the three-decade study period. In 1990, the age-standardized prevalence was 2.71 per 100,000 (95% UI: 2.08–3.46). This initial value represented the start of a prolonged trend characterized by the development of new demographic characteristics along with increasing metabolic risk factors (Figure 1).

Figure 1 Temporal trends in age-standardized prevalence rates of pancreatic cancer per 100,000 population across the MENA region, 1990–2023. MENA, Middle East and North Africa.

This trend continued without substantial disruption until the end of most of the second two-decade period. In 2000, the rate stood at 3.22 per 100,000 (95% UI: 2.66–3.81), whereas in 2007, the midpoint year of the study, it was recorded at 3.85 per 100,000 (95% UI: 3.32–4.54). There was one distinct period in which there was a slight decrease, from 2008 to 2009, when the prevalence rate fell marginally to 3.71 per 100,000 (95% UI: 3.20–4.42). However, this period of relative stability ended shortly after, as the rate entered yet another phase of increase that persisted into the 2010s (see Figure 1). In the last decade under review, the prevalence rate started increasing at an accelerated pace. By 2019, the rate crossed the mark of 4.0, standing at 4.40 per 100,000 (95% UI: 3.91–4.96). Notwithstanding the problems presented by the worldwide coronavirus disease 2019 (COVID-19) pandemic in the first years of the next decade, the burden of pancreatic cancer prevalence in the MENA region continued growing. In 2022, the rate was re-ported to be at 4.70 per 100,000 (95% UI: 4.08–5.38). The rate reached its maximum level within the reviewed time period in 2023 (Figure 1).

Sex-specific trends in pancreatic cancer prevalence

There is an ongoing inequality in the burden of pancreatic cancer between males and females within the MENA region, as shown in sex-specific data analyses, with males exhibiting consistently higher age-standardised rates of prevalence than females over the 33 years in this study (Figure 2). Both groups exhibited an increase in age-standardized prevalence rates during the same period; however, the rate of increase and the speed of the increase are likely to be a reflection of potential differences in exposure to risk factors and biological vulnerability.

Figure 2 Trends in age-standardized prevalence rates of pancreatic cancer per 100,000 population in the MENA region, stratified by sex, 1990–2023. MENA, Middle East and North Africa.

In 1990, the age-standardised prevalence rate of pancreatic cancer for males was 3.33 per 100,000 population (95% UI: 2.29–4.67) and this rate has steadily increased to 4.10 per 100,000 population (95% UI: 3.16–5.12) by the year 2000. The highest recorded prevalence rate for males occurred in 2007 at 4.74 per 100,000 population (95% UI: 3.93–5.78) before dropping temporarily between 2008 and 2010, after which time male prevalence has continued to increase. In 2023, the age-standardized male prevalence rate reached 5.52 per 100,000 population (95% UI: 4.57–6.67), demonstrating that the overall increase in male prevalence since 1990 was approximately 65.5% (Figure 2).

Figure 2 also shows the prevalence of Females starting off significantly lower in 1990 at 2.06 per 100,000 (95% UI: 1.40–2.87). However, despite the low numbers, the percentage increase in Females was more significant than in males. The number of females diagnosed steadily rose to 2.33 per 100,000 (95% UI: 1.71–2.92) in 2000 before continuing its rise to reach 3.94 per 100,000 (95% UI: 3.30–4.79) in 2023, reflecting a total percentage increase of 91.8%. Thus, it indicates that the prevalence among women in MENA for pancreatic cancer is rising at a relatively faster pace than that of men (Figure 2).

The difference between males and females has become lesser with time due to a more significant rate of increase in Females. While in 1990, the ratio of males to females was roughly 1.62, it fell down to 1.40 by 2023. However, both males and females have undergone a minor phase of a peak around 2008–2009. Over the following decade, both showed an upward trend of diagnoses. Therefore, while men continue to be at a greater risk, it can be said that the surge of prevalence in Females poses a major problem for the region.

Trends in DALYs for pancreatic cancer

DALY rates (age-adjusted) for pancreatic cancer in the North Africa and Middle East region represented a continuous, significant upward trend over the 34-year study period illustrated in Figure 3 and have been recorded at 81.82 (95% UI: 61.55–103.82) DALYs per 100,000 population from 1990 and will have increased to 127.07 (95% UI: 109.66–145.69) per 100,000 population in 2023, indicating a total regional burden of disease increase of approximately 55.3%. Within the overall increasing trend of DALYs for pancreatic cancer across this region were distinct phases of accelerating and relative stabilization in the trend of DALYs incurred. From 1990 to 2007, there was a nearly consistent increase in pancreatic cancer-related DALYs with the 2007 peak at 110.27 per 100,000, which was then followed by a short-lived period of DALY stabilization and decrease from 2008 to 2010 with a low of 105.22 DALYs per 100,000. There was an increase in DALYs incurred due to pancreatic cancer beginning in 2011 and there was a continued, consistent increase in the rate of increase and by 2016 the incidence rate of pancreatic cancer-related DALY incursions exceeded 115 DALYs per 100,000 (Figure 3).

Figure 3 Trends in in DALYs for pancreatic cancer in the MENA region, 1990–2023. DALYs, disability-adjusted life years; MENA, Middle East and North Africa.

Comparative trends in age-standardized prevalence of pancreatic cancer across Turkey, the Levant, and North Africa, 1990–2023

It was observed that the last years of the study (2019–2023) marked a period during which there were significant increases recorded in the burden experienced by the region. This is evidenced in that in the period under consideration, the DALY rate increased from 118.06 to 127.07 per 100,000 population. Of importance to mention is the fact that the last two years in this series (2022 & 2023) were marked by the recording of highest DALY rates in the whole period under analysis, along with the highest uncertainty ranges, signifying a worsening public health challenge as well as complex disease surveillance in the region (Figure 4).

Figure 4 Trends in age-standardized prevalence rates of pancreatic cancer per 100,000 population in the MENA region (Turkey, the Levant, and North Africa). MENA, Middle East and North Africa.

The standardized prevalence of pancreatic cancer was highly heterogeneous geographically in the MENA region between 1990 and 2023. Although there was a positive trend throughout the entire region during the entire period under analysis, the degree of burden of the condition and speed of its increase were very different among individual countries. Turkey had the highest rates of pancreatic cancer during the entire analyzed period, rising from 5.70 per 100,000 in 1990 to 7.70 per 100,000 in 2023. Despite experiencing a considerable drop in rates in the range from 2007 to 2010, Tur-key is still responsible for one of the most considerable regional burdens. The most considerable and volatile growth was found in Lebanon, where the rate increased from 3.13 per 100,000 in 1990 to 10.82 per 100,000 in 2020 and stabilized at 8.06 per 100,000 in 2023.

A number of nations moved from low to moderate-high levels of burden within the time period under discussion. The Egyptian prevalence rose dramatically from 1.66 to 5.62 per 100,000, representing a 238% growth rate that is the largest increase seen in the studied region over the 30-year period. Tunisia also experienced a significant jump in its prevalence rates from 3.30 to 6.49 per 100,000, especially accelerated in the last three years. In addition, Palestine demonstrated stable and uninterrupted growth from 3.06 to 5.05 per 100,000.

In terms of relatively low rates, Morocco and Algeria had the lowest figures for the region throughout the 30-year period. However, both countries had increased their prevalence rates significantly. Thus, Morocco registered one of the lowest rates, growing from 0.84 to 1.63 per 100,000, doubling its numbers compared to those recorded initially. Algeria followed the same trend, closing out the 30-year period with a 1.79 per 100,000 figure. Meanwhile, Libya and Jordan demonstrated slightly less fluctuation in their respective numbers. For example, Libya’s prevalence rose from 3.92 to 4.86 per 100,000, reaching the maximum in 2011 before stabilizing at similar levels afterwards. Likewise, Jordan’s rate grew up to 5.37 per 100,000. Finally, Syria showed moderate prevalence closing out with 1.63 per 100,000.

Trends in pancreatic prevalence across the Gulf and adjacent West Asian countries, 1990–2023

In Figure 5, longitudinal investigations into the average age-adjusted prevalence of pancreatic cancer in 33 Gulf and neighboring West Asian nations demonstrate that each of these countries experienced different patterns of long-term evolution of the disease, from rapid increases in prevalence to considerable decreases.

Figure 5 Trends in age-standardized prevalence rates of pancreatic cancer per 100,000 population in the MENA region (Gulf and adjacent West Asian countries). MENA, Middle East and North Africa.

Iraq has had the most dramatic increase in the prevalence of pancreatic cancer, increasing from 3.39/100,000 to 7.17/100,000 between 1990 and 2023, with a rapid rise in the prevalence of the disease occurring after 2010. As a result, Iraq is classified as having a high disease burden compared to other Gulf and West Asian countries. Saudi Arabia had a similar increase in prevalence over the duration of the study, with a peak prevalence rate of 5.55/100,000 in 2021, with an overall rate increase of 67%.

The UAE and Qatar, on the other hand, exhibited lower incidence of pancreatic cancer over the same period, with the UAE experiencing a 48% reduction in pancreatic cancer prevalence between 1990 (5.16/100,000) and 2023 (2.68/100,000) and Qatar experiencing a nearly identical pattern (4.93/100,000 in 1990 and 3.57/100,000 in 2023). These patterns suggest that the UAE and Qatar are successfully implementing localized interventions or are experiencing significant shifts in their populations.

Kuwait and Bahrain maintained relatively high but fluctuating rates. Kuwait’s prevalence was volatile, starting at 5.45, dropping to a low of 3.84 in 2002, and climbing back to 5.37 per 100,000 by 2023. Bahrain ended the period at 5.13 per 100,000, with most of its growth occurring in the final two years. Iran showed a consistent, moderate increase, nearly doubling its rate from 2.28 to 3.81 per 100,000.

Lower-prevalence nations like Afghanistan and Yemen showed gradual growth from very low baselines. Afghanistan increased from 0.81 to 1.21 per 100,000, while Yemen grew from 1.36 to 1.80 per 100,000. Oman maintained a moderate trajectory, ending at 3.87 per 100,000, remarkably similar to Iran’s final figure. These trends underscore the diverse epidemiological landscape across the Middle East and Central Asia (Figure 5).

Discussion

Key findings

The longitudinal analysis on the epidemiology of pancreatic cancer in North Africa and Middle East countries over the period from 1990 to 2023 highlights a disturbing shift in the disease trends as the leading cause of morbidity due to the increasing burden of non-communicable diseases in the area. From a regional perspective, there has been an increasing burden of disability measured using the DALYs that increased significantly from 81.82 DALYs per 100,000 in 1990 to 127.07 DALYs per 100,000 in 2023. This 55% increase in the burden of disease indicates that a significant health challenge exists, marked by a steady rise to 2007, a stabilization period from 2008 to 2010, and a further acceleration thereafter. This increase can be attributed to the increasing burden associated with pancreatic cancer in terms of its late stage and case fatality rate despite overall healthcare improvements in the region.

The data at the national level reveals a stark divide, in which nations such as Iraq and Egypt have become hotspots for rapid increases. The prevalence rate among Iraqis has more than doubled during the period under study, standing at 7.17 cases per 100,000 people. Egypt has shown the greatest relative increase in the data set, amounting to 238%. This trend can be explained by what is known as the “metabolic explosion,” characterized by a combination of high prevalence rates of obesity and type 2 diabetes along with high levels of tobacco use (16,17). Conversely, countries with high disease burden such as Turkey and Lebanon are likely experiencing a volatile epidemic. Turkey has been one of the highest regional prevalence rate countries throughout the period of study, while the sudden spike in prevalence in Lebanon in 2020 of 10.82 per 100,000 suggests a particularly vulnerable environment.

The observed “Gulf Paradox”—whereby the UAE and Qatar demonstrated significant long-term decreases in pancreatic cancer prevalence (48% and 27% respectively) while neighbors like Saudi Arabia saw increases—requires careful contextualization. While these declines may partially reflect genuine gains from robust primary healthcare investments and metabolic health initiatives, they are likely influenced by significant “denominator effects”. These high-income Gulf states possess unique demographic structures characterized by large populations of expatriate migrant workers who are typically younger and healthier than the general resident population. This “healthy migrant effect” can dilute population-based rates, potentially masking the true disease burden within the native-born population. Therefore, these downward trends should be interpreted as a composite of public health success and demographic shifts rather than a purely clinical decline in disease risk. In conflict-affected settings such as Syria, Yemen, and Afghanistan, our analysis found relative stability or slow growth from low baseline rates. However, these trends must not be read at face value. In these contexts, the apparent “stagnation” of the pancreatic cancer burden is highly likely a reporting artifact resulting from the systemic collapse of health infrastructure, interrupted referral pathways, and the absence of functional national cancer registries. Under-diagnosis and under-ascertainment are pervasive in areas where survival is often dictated by acute trauma or infectious disease rather than chronic oncological care. Consequently, the GBD estimates for these nations likely represent a conservative “floor” of the burden, and the actual prevalence may be significantly higher than current models can capture due to the profound data vacuum created by ongoing instability.

The policy and clinical significance of this information is substantial, necessitating a shift from reactive symptom management to proactive prevention, early detection, and palliation. Beyond general advocacy, our findings support several concrete regional interventions. First, healthcare systems must implement targeted metabolic risk screening specifically for high-risk groups—such as those with obesity or type 2 diabetes—to identify potential cases within the region’s narrow therapeutic window. Second, streamlining diagnostic referral pathways is essential to reduce the current delays that lead to late-stage presentations. Third, given the high DALY burden, there must be a significant expansion of palliative care capacity, particularly in countries with limited surgical infrastructure (18). Finally, we recommend the establishment of regional oncology collaborations where high-resource nations can support countries with weaker infrastructure through knowledge-sharing, shared diagnostic tools, and the development of unified regional cancer registries to ensure more accurate health planning (19,20).

Strengths and limitations

The key advantage of our research is grounded in applying the GBD 2023 system that offers an extremely standardized approach for epidemiology comparison in different states within North Africa and Middle East. Thanks to the implementation of age-standardized measurements, we managed to identify only those changes in the disease rates and DALYs that would not have been influenced by the demographic processes characteristic of these countries. The selection of the 34-year period (from 1990 to 2023) allows us to assess the effects of the epidemiological transition throughout the decades and reveal certain differences among the countries under consideration, such as the fast development of Egypt and decreasing rates in the United Arab Emirates. Finally, the use of 95% UIs helps provide a clear indication of how reliable the data obtained from the territories is.

These findings must be viewed through the lens of several limitations. The primary limitation discussed here is the differing qualities of primary data from country to country within the MENA region. A critical limitation is the uneven quality of primary data across the MENA region, particularly in conflict-ridden or economically unstable nations. In these settings, the GBD’s reliance on predictive modeling to fill data gaps cannot fully compensate for the total absence of VR and hospital-based registries. The apparent “stability” of pancreatic cancer rates in these regions is almost certainly a reflection of reporting collapse and limited diagnostic access rather than epidemiological reality. Furthermore, our analysis of high-income Gulf nations is limited by our inability to fully disentangle the “healthy migrant effect” from genuine public health gains, suggesting that population-level rates may under-represent the burden in native-born citizens. Correspondingly, even though we have demonstrated a relationship between metabolic risk factors, such as obesity and diabetes, and the incidence of pancreatic cancer, the ecological nature of the study does not allow for the identification of true cause and effect relationships at the individual level. Finally, the data spanning the 2020–2023 period must be interpreted with caution due to the potential distorting effects of the COVID-19 pandemic. Disruptions to diagnostic services, surgical delays, and the pivoting of healthcare infrastructure toward pandemic response may have interrupted referral pathways and regional registry operations. These factors could result in a temporary under-ascertainment of cases or reporting delays, potentially masking the true biological burden. This is further reflected in the significantly wider UIs recorded for 2022 and 2023, which indicate increased data volatility and more complex disease surveillance during the pandemic recovery phase.

Conclusions

This research shows that there is a major, and worsening, public health issue in the Northern African/Middle Eastern region. To put this into perspective, the 55% increase in age-standardized DALYs since 1990 illustrates that pancreatic cancer is not only no longer an “afterthought”, but is also a primary contributor to the total number of non-communicable diseases in this region. There are large inequities in regard to rates of pancreatic cancer across the different nations, with significant increases in pancreatic cancer incidence rates in Egypt and Iraq juxtaposed with substantial drops in pancreatic cancer incidence rates found in the United Arab Emirates and Qatar; consequently, it is evident the trajectory is not the same across this region and is substantially affected by the health policy and metabolic risk profile. The Northern African/Middle Eastern region of the world is fighting against a deadly disease, which is frequently diagnosed late enough that curative measures are no longer possible. Therefore, it is necessary to implement a multi-faceted regional strategy that addresses the specific inequities identified in this study. This should involve prioritizing targeted metabolic risk screening for populations heavily impacted by the “metabolic explosion”, alongside a concerted effort to improve diagnostic referral pathways for early intervention. While aggressive primary prevention regarding tobacco and metabolic health remains the long-term goal, the immediate focus must also include expanding palliative care resources to manage the existing high-fatality burden. Furthermore, fostering regional oncology collaborations between nations like the UAE and Qatar, who have demonstrated successful burden reductions, and those with fractured healthcare systems will be critical for standardizing surveillance and developing shared strategies to mitigate the impact of pancreatic cancer across the entire MENA region.

Acknowledgments

This work was supported by the Princess Nourah bint Abdulrahman University Researchers Supporting Project, Riyadh, Saudi Arabia (No. PNURSP2026R364).

Footnote

Reporting Checklist: The authors have completed the GATHER reporting checklist. Available at https://jgo.amegroups.com/article/view/10.21037/jgo-2026-0539/rc

Peer Review File: Available at https://jgo.amegroups.com/article/view/10.21037/jgo-2026-0539/prf

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jgo.amegroups.com/article/view/10.21037/jgo-2026-0539/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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