Pancreatic Cancer Screening
Pancreatic cancer is the fourth leading cause of cancer death for both men and women. Surgical resection is the only potentially curative treatment for exocrine pancreatic cancer, but because of the late presentation of the disease, only 15 to 20 percent of patients are candidates for surgery. Furthermore, the prognosis of pancreatic cancer is poor even in those with potentially resectable disease. Five-year survival rates approach 25% if the cancers are surgically removed while they are still small and have not spread to the lymph nodes.
In general, pancreatic cancer affects more individuals inhabiting the Western/industrialised parts of the world; the highest incidence is reported among Maoris in New Zealand, native Hawaiians, and Black American populations, while people living in India and Nigeria have the lowest reported incidence.
Why is pancreatic cancer so difficult to diagnose?
Pancreatic cancer is treatable when caught early, however the vast majority of cases are not diagnosed until too late. Symptoms are often vague and easily confused with other diseases.
In general, pancreatic cancer affects more individuals inhabiting the Western/industrialised parts of the world; the highest incidence is reported among Maoris in New Zealand, native Hawaiians, and Black American populations, while people living in India and Nigeria have the lowest reported incidence.
Why is pancreatic cancer so difficult to diagnose?
Pancreatic cancer is treatable when caught early, however the vast majority of cases are not diagnosed until too late. Symptoms are often vague and easily confused with other diseases.
Can we perform a screening test for early detection of pancreatic cancer?
Studies have shown that screening of high-risk individuals using endoscopic ultrasound (EUS), CT scans and MRI scans can detect asymptomatic, early pancreatic lesions and cysts.
Studies have shown that screening of high-risk individuals using endoscopic ultrasound (EUS), CT scans and MRI scans can detect asymptomatic, early pancreatic lesions and cysts.
What defines a high-risk individual?
-BRCA2 -p16 -Peutz Jeghers Syndrome (PJS) -Familial adenomatous polyposis (FAP) -Lynch Syndrome (MLH1 / MSH2 / MSH6) |
4. People with chronic pancreatitis 5. People with hereditary pancreatitis 6. People of Ashkenazi Jewish descent 7. People over the age of 50 8. People with pancreatic cysts |
In the past decade, a pancreatic cancer screening program was developed at Johns Hopkins, USA and Erasmus MC University Medical Centre, Netherlands and adopted across other centers in USA and Europe.
The International Cancer of the Pancreas Screening (CAPS) Consortium was formed in 2010 to help organise global pancreatic screening. Dr Saxena received expert training in pancreatic cancer screening during her fellowship at Johns Hopkins. She now contributes to the International CAPS consortium and is actively leading international research in this very exciting field.
It is hoped that screening may prove effective, particularly when applied to a select groups of patients known to have an increased risk of developing pancreatic cancer such as individuals with a strong family history of pancreatic cancer.
The optimal time to begin screening is unclear, but some groups recommend beginning at age 40 for those with hereditary pancreatitis and 10 to 15 years before the age at which pancreatic cancer was diagnosed in the youngest individual in the family individuals with an inherited predisposition. In patients with PJS, screening for pancreatic cancer is recommended at age 30 years. There is no consensus on the appropriate interval for screening and also no consensus as to the optimal screening strategy.
Prior to the 1990's, it was not widely appreciated how often pancreas cancer is an inherited disease. Now we know that individuals with abnormalities in certain genes, such as BRCA2, p16, HNPCC, and individuals with histories of familial pancreatitis and Peutz-Jeghers syndrome are all predisposed to pancreatic cancer. These are important discoveries. However, individuals who inherit damage to one of these genes still represent only a modest proportion of all those individuals at risk of developing pancreatic cancer. Secondly, we now know much more about the changes in the DNA and other molecules in the pancreas cells that give rise to pancreatic cancer. Most of these changes are not inherited and occur as the result of factors such as smoking, diet, and age. Importantly, pancreatic cancer researchers are characterizing these specific changes in DNA and other molecules. Armed with this knowledge, it is hoped that over the next few years, specific and extremely sensitive screening tests will be developed. Such a screening test will be able to detect pancreatic cancer at an early stage when it still cannot be visualized using state of the art diagnostic imaging techniques. Once such a screening panel is in place, it can be offered to individuals who, from their family history, know that they are at particular risk of developing this disease.
The International Cancer of the Pancreas Screening (CAPS) Consortium was formed in 2010 to help organise global pancreatic screening. Dr Saxena received expert training in pancreatic cancer screening during her fellowship at Johns Hopkins. She now contributes to the International CAPS consortium and is actively leading international research in this very exciting field.
It is hoped that screening may prove effective, particularly when applied to a select groups of patients known to have an increased risk of developing pancreatic cancer such as individuals with a strong family history of pancreatic cancer.
The optimal time to begin screening is unclear, but some groups recommend beginning at age 40 for those with hereditary pancreatitis and 10 to 15 years before the age at which pancreatic cancer was diagnosed in the youngest individual in the family individuals with an inherited predisposition. In patients with PJS, screening for pancreatic cancer is recommended at age 30 years. There is no consensus on the appropriate interval for screening and also no consensus as to the optimal screening strategy.
Prior to the 1990's, it was not widely appreciated how often pancreas cancer is an inherited disease. Now we know that individuals with abnormalities in certain genes, such as BRCA2, p16, HNPCC, and individuals with histories of familial pancreatitis and Peutz-Jeghers syndrome are all predisposed to pancreatic cancer. These are important discoveries. However, individuals who inherit damage to one of these genes still represent only a modest proportion of all those individuals at risk of developing pancreatic cancer. Secondly, we now know much more about the changes in the DNA and other molecules in the pancreas cells that give rise to pancreatic cancer. Most of these changes are not inherited and occur as the result of factors such as smoking, diet, and age. Importantly, pancreatic cancer researchers are characterizing these specific changes in DNA and other molecules. Armed with this knowledge, it is hoped that over the next few years, specific and extremely sensitive screening tests will be developed. Such a screening test will be able to detect pancreatic cancer at an early stage when it still cannot be visualized using state of the art diagnostic imaging techniques. Once such a screening panel is in place, it can be offered to individuals who, from their family history, know that they are at particular risk of developing this disease.
© Dr Payal Saxena 2015
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