Screening for Pancreas Cancer
According to the cancer statistics of America, the overall incidence of this dreadful disease has steadily increased over the past 40 years. It is an aggressive cancer. By the time patients consult their doctors, about 80% of them will already have advanced disease. It is not surprising that the average survival for all patients is about 6 months.
The question then is whether if this disease can be detected earlier, before the onset of any symptoms, and if this strategy of screening can result in better outcomes. Indeed, studies have shown that for a pancreatic cancer less than 1cm without invasion into the surrounding tissues or lymph nodes, surgery to remove the tumour can result in long-term survival (references: Hepatogastroenterology 1999; 46: 8-15 & Pancreas 1998; 16: 396-401)
Because of the relatively low prevalence of disease, when compared to cancers like colon cancer, breast cancer, etc, it is not feasible to screen the general population. Therefore, only high-risk individuals need to be screened.
High-risk individuals who will benefit from screening include patients with:
- Chronic pancreatitis
- Family history of pancreas cancer (at least 2 first-degree relatives diagnosed with pancreas cancer)
- Hereditary pancreatitis
- Peutz-Jeghers Syndrome
- Cystic Fibrosis
- Familial atypical multiple mole melanoma (FAMMM)
There is another group of individuals who are at moderate risk to develop pancreas cancer:
- Hereditary breast or ovarian cancer (two to ninefold risk)
- Smokers (two to fivefold risk)
They may benefit from screening as well. Hence more studies are needed.
The ideal screening tool should be both relatively inexpensive and noninvasive, with high accuracy. Until now, no ideal single screening test exists for pancreatic cancer.
According to a paper published in 2009, titled “Pancreatic Cancer Screening – State of the Art”, the authors recommended using endoscopic ultrasonography (EUS) as the first-line screening method. EUS is able to detect tumours as small as 5mm, as well as the presence of invasion into the surrounding major blood vessels. If need be, a CT scan may be added in combination.
The authors did not mention the frequency that screening should be done. Certainly, more information is needed before this can be recommended as standard of care. And the authors did qualify their stand by concluding their paper with this statement: ”Multiprospective studies are needed to determine whether screening for early pancreatic neoplasia and timely intervention results in a decreased incidence and mortality for pancreatic cancer in high-risk individuals.”
If you have any questions pertaining to pancreas cancer and pancreatic cancer screening, diagnosis or treatment, please do not hesitate to consult us at Nexus Surgical Digestive Disease Centre.