Pancreatic cancer is the third deadliest cancer in the United States, but it doesn’t have to be that way. While late-stage diagnoses are difficult to treat, five-year survival rates are highest when the disease is detected at an early stage.
Identifying people at risk and prioritizing early detection could save thousands of lives, according to Diane Simeone, MD, a pancreatic surgeon and director of UC San Diego’s Moores Cancer Center. HealthyWomen spoke with Simeone to learn more about this secret disease.
Are pancreatic cancer symptoms different in women than in men?
There is no data to actually support differences in symptoms by gender. Symptoms of pancreatic cancer tend to be nondescript and vague for everyone, such as mild upper abdominal pain or bloating. Symptoms tend to appear only when the disease is advanced. That’s why it’s fatal. One of the red flags for pancreatic cancer is a new diagnosis of diabetes along with weight loss. Another red flag is jaundice, which is when the eyes or skin turns yellow.
Does having a history of diabetes or pancreatitis affect your risk of pancreatic cancer?
Diabetes is linked to pancreatic cancer in two ways. First, having type 2 diabetes doubles your risk, and second, weight loss following a new diagnosis of diabetes is a red flag for pancreatic cancer. The risk of developing cancer doubles every time you see chronic inflammation in pancreatitis, which is inflammation of the pancreas.
What role does family history play in pancreatic cancer risk?
It was found that there was a genetic link. This means that pancreatic cancer is caused by DNA changes in 10% of cases. However, when family history is taken into account, it is thought that the rate could be up to 20%.
The pancreatic cancer community is advocating for people to get germline testing, a blood test that can detect inherited genetic defects known to cause cancer.
What mutations are associated with pancreatic cancer, and why should you care about which ones you have?
The BRCA gene, which is commonly associated with breast cancer, is also closely related to pancreatic cancer. We believe that germline testing for cancer is important because delayed detection can lead to the worst outcomes. This is not done consistently today. A completely new strategy needs to be developed, one that includes routine germline testing, especially for people at risk for pancreatic cancer.
How can people at high risk protect themselves from pancreatic cancer?
I tell people with risk factors to go to a specialist center and work with a multidisciplinary team to assess their risk and create an individualized plan to manage it. The plan will likely include the gonad testing and routine testing I mentioned. The pancreas is not easy to access with an endoscope, and there is no way to reliably detect pancreatic cancer with a single blood test. However, there are markers that appear in the blood, and detection methods are improving as pancreatic tumors and their genetic makeup are studied.
Are clinical trials a good option for patients with pancreatic cancer?
Yes. Clinical trials are always an important option to consider. Trials are underway to test the success of screening for early detection, and new treatments are increasingly being tested clinically. Leading researchers are working to improve pancreatic cancer survival rates to 50% over the next decade through collaboration, funding and research for early detection, screening, risk modeling and prevention. These studies aren’t just for patients. Family members can also participate.
How do health care providers decide which treatment option is right for a particular patient?
Although some types of cancer can be treated at a nearby cancer center, it is recommended that pancreatic cancer be treated at the National Cancer Institute Comprehensive Cancer Center. It is important to assemble a multidisciplinary team to help patients enroll in trials, undergo germline testing, have their tumors sequenced, and gather as much information as possible to find the best course of treatment.
Treatment may include a combination of surgery, radiation, and chemotherapy. There are promising breakthroughs in immunotherapy and vaccines that require validation in clinical trials. And new treatments targeting a gene called RAS, whose mutations cause cancer, may have an impact. However, any treatment will be most effective if the cancer is discovered at an early stage.
What role does diet play in pancreatic cancer patients?
The best data on diet show that a healthy, balanced diet low in processed foods reduces cancer risk. Exercise is also important. One study found that people who walk 7,500 steps a day can add 10 years to their lifespan. There is growing data showing that exercise can not only lower cancer risk but also help the body respond better to cancer treatment.
Are there racial and socioeconomic disparities related to pancreatic cancer?
Abundant data show that underrepresented groups are less frequently offered germline testing and are underinformed about their eligibility for cancer screening.
With 67,530 new cases of pancreatic cancer in the United States this year, most patients will die from the disease without a chance to fight it. Late-stage diagnosis was and remains a major problem. When I began my career as a pancreatic surgeon and scientist 30 years ago, the five-year survival rate was 5%. Now it’s 13%. It is the second leading cause of cancer death in Korea.
I advise my patients to advocate for themselves. It is very important to listen to your body, listen to other opinions, and make an effort to be heard and seen. Your life is at stake. If these numbers and the devastating impact of this disease on patients and families are to change, it is important that we all advocate for a focus on early detection.
This training material was created with support from:m Merck.
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