November is Pancreatic Cancer Awareness Month
According to the American Cancer Society, 1 in 4 deaths in the United States are due to cancer – 1,600 deaths daily. And pancreatic cancer is on the verge of moving from fourth place past breast and colorectal cancer into the second leading cause of death after lung cancer.
What makes it all so terrible is that the disease is usually caught late and when that happens, survival is less than 5%. For about 20% of pancreatic cancer patients their tumor is detected early enough to be treated with surgery. Of those 20% about one third survive at least 5 years
So the best chance of beating pancreatic cancer is early detection so it can be treated when it is still “treatable.” Below is a list of people who should be screened for early detection of pancreatic cancer. Do you have:
- Two or more first-degree relatives with pancreatic cancer (parents, siblings, child)
- One first-degree relative diagnosed before age 50
- Two or more second-degree relatives (grandparent, aunt/uncle/nephew/niece/half-sibling) with pancreatic cancer, of whom one developed it before age 50
- Over the age of 50 and develop diabetes. Up to 85% of pancreatic patients develop diabetes 2-3 years earlier
- A previous case of pancreatitis
- A long term smoking history
- A history of a BRCA 2 genetic mutation or certain genetic syndromes listed below (modified from the University of Chicago):
Genetic Syndromes Associated with Pancreatic Cancer
From University of Chicago Pancreatic Cancer Center
| Genetic Syndrome | Genetic Mutation | Clinical Clues |
| Hereditary pancreatitis | PRSS1 | History of pancreatitis starting at an early age |
| Breast-ovarian cancer syndrome | BRCA 2 | History of breast and/or ovarian cancer |
| Hereditary nonpolyposis colorectal cancer syndrome | Mismatch repair genes | Personal or family history of early colorectal cancer |
| Familial atypical multiple mole melanoma syndrome (FAMMM) | CDK2NA/p16 | Multiple melanomas with or without history of pancreatic malignancy |
| Peutz-Jeghers syndrome | STK11/LKB1 | Benign polyps of the gastrointestinal tract with pigmented macules on the lips, inner lining of the cheeks, and hands/feet |
Most of the early detection of pancreatic cancer is done either by radiology procedures such as a CT or MRI of the abdomen, or endoscopy using a small telescope placed through the throat and stomach into the duodenum (the top of the small intestines) where an attached ultrasound transducer can more easily see the tumor. In the April issue of the journal Gastroenterology 225 asymptomatic patients at high risk for pancreatic cancer were screened using these tests. Pancreatic cancer or early precursors were found in 14% of high-risk patients under age 50, 34% of patients ages 50-59 and 53% of patients aged 60 -69.
Recently a small preliminary study showed promising results from a simple blood test that detects tiny epigenetic alterations believed to be the earliest signs of pancreatic cancer. If confirmed, this blood test could help greatly improve survival rates, which really haven’t improved much over the past few decades.
The study was led by Nita Ahuja, MD, an associate professor of surgery, oncology and urology at the Johns Hopkins University School of Medicine in Baltimore, Maryland and was published in Clinical Cancer Research (2013; doi:10.1158/1078-0432.CCR-12-3224).
The study found two genes, BNC1 and ADAMTS1, which together were present in 81% of blood samples from 42 people with early-stage pancreatic cancer, but not in patients without the disease or in patients with a history of pancreatitis, a risk factor for pancreatic cancer. This type of accuracy is much better than the commonly used PSA antigen test for prostate cancer that only detects about 20% of prostate cancers. Hopefully, more and better tests and more awareness will lower the deadly risk of this very bad disease.
