Pancreatic Cancer Screening & Prevention



Over the past several decades, the incidence of pancreatic cancer has been increasing and the disease is now the fifth leading cause of cancer death in the United States. Pancreatic cancer accounts for approximately 2% of all newly diagnosed cancers in the United States each year, but 5% of all cancer deaths. Pancreatic cancer is often called a silent killer because it usually does not cause any recognizable symptoms until it is advanced and has spread outside the pancreas. As a result, the majority of pancreatic cancers are not diagnosed until they have reached advanced stages and are considered incurable.


Heredity or Genetic Factors

Hereditary associations account for only a small fraction of the total number of cases of pancreatic cancer. Only 7 to 8% of patients with pancreatic cancer have one or more family members with pancreatic cancer. Some other inherited syndromes are associated with an increased incidence of pancreatic cancer, including familial adenomatous polyposis, familial atypical multiple mole melanoma and hereditary pancreatitis. Forty percent of patients with hereditary pancreatitis develop pancreatic cancer by the age of 70. The risk of developing pancreatic cancer is approximately 75% if the pattern of inheritance is through the father. Researchers have identified two gene mutations in families with hereditary pancreatitis. This discovery has helped to allow for screening in families with a history of familial pancreatitis.

Environmental or Non-Genetic Factors

Although the causes of pancreatic cancer remain ambiguous, researchers have identified some risk factors that are associated with pancreatic cancer; however, these environmental factors do not account for the majority of cases.

Cigarette Smoking: The most consistent risk factor associated with pancreatic cancer is cigarette smoking. Cigarette smokers are two to three times more likely to develop pancreatic cancer than nonsmokers. Approximately 30% of pancreatic cancers are believed to directly result from smoking.

Age: Research indicates that the risk of pancreatic cancer increases with age. The average age at diagnosis is 70. People under 40 rarely develop pancreatic cancer.

Diet: The results of several clinical studies indicate that individuals who consume a diet high in fat and low in fruits and vegetables and dietary folate may be at an increased risk of pancreatic cancer. Some researchers have reported an association between meat and fish consumption and the risk of pancreatic cancer. This may be related to the carcinogenic and mutagenic effects of heterocyclic aromatic amines present in cooked meat and fish.

Obesity: Research indicates that individuals who are obese are at an increased risk for developing pancreatic cancer. Researchers used data from two United States cohort studies to evaluate the relationship between obesity, physical activity and the risk of pancreatic cancer. The study involved 46,648 men ages 40 to 75 and 117,041 women ages 30 to 55, with10-20 years of follow-up. The results indicated that individuals with a higher body mass index (BMI) had an increased risk of pancreatic cancer compared with individuals with a lower BMI. Furthermore, moderate activity reduced the risk of pancreatic cancer, especially among individuals with a high BMI.

Occupational exposure: Some studies suggest that exposure to petroleum and other chemicals might increase the risk of pancreatic cancer. Petrochemical workers, hairdressers and rubber workers appear to be at an increased risk of pancreatic cancer.

Pancreatitis: Chronic pancreatitis refers to a long-term inflammation of the pancreas. Patients with non-hereditary chronic pancreatitis appear to have an increased incidence of pancreatic cancer; however, the majority of individuals with chronic pancreatitis never develop pancreatic cancer.

Diabetes: There is an increased incidence of pancreatic cancer among patients with diabetes. Individuals with diabetes develop pancreatic cancer twice as often as those who do not have diabetes. Onset of diabetes may herald the appearance of pancreatic cancer, particularly if the diabetes occurs during or beyond age 50. Diabetes is present in 60-80% of patients with pancreatic cancer and the majority of patients were diagnosed within 2 years of the cancer. Patients with diabetes and cancer more often do not have a family history of diabetes. It appears that a subgroup of patients with late onset diabetes who have no family history of diabetes may be at an increased risk. Abnormalities of glucose metabolism in individuals who do not have diabetes are also associated with an increase in pancreatic cancer.

Prevention of Pancreatic Cancer


Since the development of pancreatic cancer is poorly understood, it is difficult to make recommendations for prevention. Currently, the best approach is to avoid the risk factors for this disease and modify diet and lifestyle.

Avoid Smoking: Since cigarette smoking is responsible for 30% of pancreatic cancers, it would be wise to avoid or quit smoking.






While researchers have long evaluated the link between diet and all cancers, there also has been research to investigate the link between diet and pancreatic cancer. Recent studies have indicated that reducing intake of well-cooked meat and fish and increasing the intake of fruit and vegetables might be important for preventing pancreatic cancer. In addition, the results of a recent clinical study indicate that a high intake of dietary folate significantly reduces the risk of pancreatic cancer. Some rich sources of dietary folate are leafy greens, turnip greens, dry beans, peas and some fruits and vegetables.


Screening and Early Diagnosis of Pancreatic Cancer


Pancreatic cancer has a high mortality rate because it is difficult to find the disease early. Pancreatic cancer usually does not cause any recognizable symptoms until it is advanced and has spread outside the body. Since the pancreas is deep inside the body, it is difficult to detect tumors during a routine check-up. Currently, there are no screening tests to find this disease early in individuals who have no symptoms.

Currently, computerized tomography (CT) scans are the best way to detect small pancreatic cancers. Endoscopic ultrasound will detect small pancreatic cancers not detected by CT scans. The cancer marker CA 19-9 is sometimes elevated in early cases of pancreatic cancer.

There are no specific recommendations for screening people who are at a high risk for pancreatic cancer. However, one strategy would be to perform a screening CT for persons with familial syndromes associated with an increased risk of pancreatic cancer. In high-risk patients, endoscopic ultrasound is performed if the CT scan is equivocal or negative. A CA 19-9 should be performed on all high-risk patients.

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