November is National Pancreatic Cancer Awareness Month1,2
Pancreatic Cancer: Screening in Your Practice?1,2
Early detection and diagnosis of pancreatic cancer is a complex challenge. An asymptomatic malignancy that affects an organ deep inside the body, pancreatic cancer is often diagnosed well after the disease has metastasized.
Unlike screening for breast cancer or prostate cancer, there is no recommended screening routine for pancreatic cancer in individuals who aren’t at an increased risk of developing it. That’s because no tests have been proven to reduce the mortality rate in people with pancreatic cancer.
There are, however, strategies for screening in people who are at highest risk of developing pancreatic cancer.
People at increased risk of developing pancreatic cancer1,2
When screening for pancreatic cancer in those with increased risk, we can start by looking at the risk factors themselves. Some risks factors can be changed and some cannot.
Risk factors for pancreatic cancer that can be changed1,2
Risk factors that can’t be changed
Age: The average age at the time of diagnosis is 70.
Sex: Men are slightly more likely to develop pancreatic cancer than women.
Race: African Americans are slightly more likely to develop pancreatic cancer than whites.
Family history: Pancreatic cancer seems to run in some families, though most people who get pancreatic cancer do not have a family history of it.
Screening in people who have a family history of pancreatic cancer may involve inherited genetic syndromes. Examples of genetic syndromes that can cause pancreatic cancer include:
- Hereditary breast and ovarian cancer syndrome, caused by mutations in the BRCA1 or BRCA2 genes
- Hereditary breast cancer, caused by mutations in the PALB2 gene
- Familial atypical multiple mole melanoma (FAMMM) syndrome, caused by mutations in the p16/CDKN2A gene and associated with skin and eye melanomas
- Familial pancreatitis, usually caused by mutations in the PRSS1 gene
- Lynch syndrome, also known as hereditary non-polyposis colorectal cancer (HNPCC), most often caused by a defect in the MLH1 or MSH2 genes
- Peutz-Jeghers syndrome, caused by defects in the STK11 gene. This syndrome is also linked with polyps in the digestive tract and several other cancers
Chronic pancreatitis (due to a gene change): Chronic pancreatitis is sometimes due to an inherited gene mutation. People with this inherited (familial) form of pancreatitis have a high lifetime risk of pancreatic cancer.
Factors with an unclear effect on risk
Diet
Ingesting red and
processed meats,
saturated fats, and
sugary drinks may
also increase this risk.
More research is
needed in this area.
Physical inactivity
Some research
shows a sedentary
lifestyle might
increase pancreatic
cancer risk.
Coffee
Some older studies
say drinking coffee
might increase the
risk of pancreatic
cancer, but more
recent studies have
not confirmed this.
Alcohol
Some studies
demonstrate a link
between heavy
drinking and
pancreatic cancer.
Infections
Some data suggest
ulcer-causing bacteria
Helicobacter pylori
(H. pylori) or infection
with Hepatitis B may
increase the risk of
getting pancreatic
cancer.
MRI scans: in people with a family history of pancreatic cancer1,2
MRI scans can be used in people who might be suspected of having pancreatic cancer, or those who are at high risk of developing it based on their family history.
MR Cholangiopancreatography
This is a non-invasive imaging test that looks at the pancreatic ducts and bile ducts to see if they are blocked, narrowed, or dilated.
These tests can help show if someone might have a pancreatic tumor that is blocking a duct. They can also be used to help plan an upcoming surgical procedure.
MR Angiography
Used to examine the patient’s vasculature, X-ray angiography is used to determine if pancreatic cancer has progressed through the walls of certain blood vessels, and helps the surgical team determine if the tumor can be excised without damaging the surrounding vasculature.
Traditional X-ray angiography can be uncomfortable for patients, as it involves a catheter which is inserted into the patient’s thigh and threaded up through an artery to the pancreas. This procedure often requires a local anesthetic.
However, angiography can also be performed with a CT scanner (CT angiography) or an MRI scanner (MR angiography) with much less discomfort for the patient. These procedures can yield the same information without the need for a catheter in the patient’s thigh.
References:
- Pancreatic cancer early detection, diagnosis and staging. Cancer.org. Accessed August 21, 2023. https://www.cancer.org/cancer/types/pancreatic-cancer/detection-diagnosis-staging/detection.html.
- Pancreatic cancer screening. Johns Hopkins Medicine. Accessed August 21, 2023. https://www.hopkinsmedicine.org/health/conditions-and-diseases/pancreatic-cancer/pancreatic-cancer-screening#:~:text=While%20there%20are%20no%20widely,the%20presence%20of%20associated%20conditions.