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Advancements in cancer care have resulted in better screening and treatment options. Yet unlike mammograms for breast cancer or colonoscopy for colon cancer, there is still no universal screening tool for pancreatic cancer.
The American Cancer Society estimates that while pancreatic cancer accounts for about 3% of cancers in the U.S. it accounts for 7% of cancer deaths. James Farrell, MD, pancreatic disease expert at Smilow Cancer Hospital and director of the Yale Center for Pancreatic Disease explains that early detection is key because pancreatic cancers can be treated with surgery, but only if they are caught early enough. Therefore, the best option is to identify patients who have an increased risk and provide them with surveillance.
Who is considered high risk for pancreatic cancer?
High risk populations include:
- Those with a family history or genetic predisposition of pancreatic cancer
- Those with identified pancreatic cysts
- New onset of diabetes in middle age
Patients who have risk factors can be monitored with a variety of strategies, typically starting at age 50. Blood tests can include tumor markers and look at variables such as blood sugar levels. Non-invasive imaging can help identify pre-cancerous cysts. Small masses that are found can then be biopsied using endoscopic ultrasound. The Pancreatic Cancer Early Detection Program provides surveillance, evaluates risk for patients and conducts genetic counseling.
“The majority of our patients in surveillance programs do not end up getting cancer or surgery,” said Dr. Farrell. “But there are people with suspicious areas on CT or MRI imaging, where we did go in with endoscopic ultrasound and find cancers, and we found them at an early enough stage where surgery was an option. It’s encouraging for all of us to keep going and that’s because we know that if we keep looking in a very methodical, organized manner, we’re going to find cases.”
Genetic testing for cancer
Family history is the strongest indicator of pancreatic cancer risk. In families where there are several cases of pancreatic cancer, genetic testing may reveal common gene mutations commonly associated with other cancers such as BRCA1, BRCA2, PALB2, and ATM.
“If patients have a family history of breast cancer and they undergo genetic testing, they’ll be tested for a variety of genes. Some of those genes have overlap importance with risk factors for pancreatic cancer,” said Dr. Farrell. “That’s often a mechanism whereby we see patients in our clinic. These patients have been evaluated for breast cancer and have a family history of breast cancer and then the germline mutations in these specific genes have been identified.”
Other common genetic abnormalities that are inherited include Lynch syndrome, the p16 gene and Peutz-Jeghers syndrome. Patients who discover that they have one of these gene mutations can then notify their family members, allowing them the opportunity to get their own genetic testing done.
Another benefit of surveillance programs is the opportunity for patients to take part in research studies. The discovery of novel gene mutations may open the door to future screening options or treatments down the line. Dr. Farrell says he hopes one day there will be a blood test that can be used for universal pancreatic cancer screenings.
Patients who want to learn more about their risk should speak with their primary care doctor or gastroenterologist. Patients who suspect they have a high risk can also reach out to the Pancreatic Cancer Early Detection Program for an evaluation.
