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Increasing survival rates of patients with pancreatic cancer by earlier identification

Nature Clinical Practice Oncology volume 3, pages 346–347 (2006)Cite this article

The lifetime risk of developing pancreatic ductal adenocarcinoma (PDAC) is 1%. This disease is widely regarded as incurable because median survival figures are poor; nevertheless, reasonable rates of survival are possible in the 10% of patients who are treated early with resection and adjuvant chemotherapy.1

Earlier detection of PDAC could save a greater proportion of those patients who develop the disease. Unfortunately, the early warning signs of PDAC are easy to confuse with symptoms of less sinister gastrointestinal disorders. Use of the serum marker CA 19-9 might be valuable in adding weight to the argument for specialist investigation in individuals, but this marker shows poor sensitivity for small tumors. Information on early warning signs of PDAC should perhaps be targeted toward selected populations with a heightened risk, and their clinicians. The risk of developing PDAC rises dramatically after the age of 50 years. The only recognized avoidable risk factors for PDAC are smoking and obesity. Smoking more than doubles the chance of developing the disease, accounting for approximately 30% of PDAC cases each year.2 A recent report suggested that 1% of patients diagnosed with late-onset diabetes go on to develop PDAC within the following 3 years.3 It is possible that, if the 2,122 diabetic patients in this study had undergone surveillance after the diagnosis of diabetes, the 18 patients who subsequently developed cancer could have been diagnosed earlier. Ten of these 18 patients were diagnosed with cancer within 6 months of diagnosis of diabetes, of whom only 3 were treated with curative intent. Estimates of the increased PDAC risk associated with chronic pancreatitis range from twofold to 19-fold.4 The inherited form of pancreatitis gives a much greater risk (35-fold), but is a rare condition.5 For patients who have chronic pancreatitis, awareness of their increased risk of PDAC could increase vigilance. Cancer screening in patients with hereditary pancreatitis could be justified, but the condition is rare and the number of individuals likely to develop PDAC is small, estimated at around 1–2 families per million population.5

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Authors and Affiliations

  1. the lead scientist on the EUROPAC project,

    William Greenhalf

  2. Head of the School of Cancer Studies, University of Liverpool, Liverpool, UK

    John P Neoptolemos

Authors
  1. William Greenhalf
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  2. John P Neoptolemos
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Correspondence to John P Neoptolemos.

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The authors declare no competing financial interests.

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The European Registry of Hereditary Pancreatitis and Familial Pancreatic Cancer (EUROPAC)

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Greenhalf, W., Neoptolemos, J. Increasing survival rates of patients with pancreatic cancer by earlier identification. Nat Rev Clin Oncol 3, 346–347 (2006). https://doi.org/10.1038/ncponc0483

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