It really affects everyone. Men, women, people of all color, of all sizes, are affected by pancreatic cancer. The one preventable risk factor that we have is tobacco use. We know that tobacco causes many cancers, and pancreas is certainly high on that list. Less than one in ten individuals have a known genetic risk factor. However, this broader group — those who have one or two family members, particularly if that family member was affected at a young age — that’s a much broader group and that may represent up to 10 or 20% of individuals that are at increased risk. And that’s an important group to follow closely because we do now have some effective screening tests for early detection in those high-risk groups.
There are screening tests for pancreas cancer. The limiting factor is they are not as accurate as say colonoscopy is, and so we target those to higher risk individuals — those that have multiple family members or a known genetic risk or a cyst on their pancreas that may have been detected incidentally. The two best screening tests right now are MRI and endoscopic ultrasound.
What we’ve recently found is that pancreas cysts are actually very common. In a study we just published this year looking at MRI scans done on a very high-resolution MRI scan here at Mayo Clinic, we find small cysts in up to 30 to 40% of all individuals, so obviously most of those are not at high risk. However, we’ve been able to further stratify those into high risk, medium risk and low risk based on certain characteristics of those cysts, and we can appropriately track those individuals in a surveillance program or, in rare cases, recommend surgical removal of the cyst before it turns cancerous.
We’re really seeing major areas of progress on multiple fronts from personalized and precision medicine, with genetic classifications of tumors pushing the boundary of who we can remove the tumor surgically and early diagnosis with screening surveillance in appropriate individuals.
There is hope for this cancer. We can cure individuals with pancreas cancer, and so it’s very important to go to a center that has a comprehensive approach because we are really shifting that goalpost of where we are right now with pancreas cancer. We’re not there yet in terms of curing as many people as we want to. We’ve got a long ways to go, but we’re certainly moving in the right direction, and I think those centers where you have a comprehensive approach with gastrointestinal specialists, surgical specialists, oncology, radiation, radiology, palliative care — all of those specialists on one team such as we have here at Mayo Clinic Florida — I think they’re going to offer the best possibility of a cure.