Siteman to Offer Pancreatic Cancer Screening for High-Risk Patients

Jason Merrill

April 13, 2009 – Through advances in diagnostic screening, the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine is now offering pancreatic cancer screening for people at high risk for the disease.

“This screening program is important because the people who are most likely to be cured of pancreatic cancer are those in whom it’s found early and surgery is successful at removing the entire tumor,” says Dayna Early, MD, a Washington University gastroenterologist at Siteman.

The screening program involves two tests. One is an endoscopic ultrasound, where physicians look at the pancreas from the stomach and the duodenum, and the second procedure is magnetic resonance cholangiopancreatography (MRCP), an MRI to visualize the pancreas, biliary tract and pancreatic ducts.

Screening is encouraged for patients at high risk for developing pancreatic cancer but is not recommended for the general population. “The most common group would be those with a family history of pancreatic cancer in two or more first-degree relatives – first degree being one of your own parents, your children or your brother or sister,” Early says. “There are also other less common hereditary cancer syndromes that put people at risk for pancreatic cancer.”

The Siteman program is multidisciplinary, involving Washington University surgeons, medical oncologists, genetic counselors, gastroenterologists and radiologists.

“We introduce people to the program through the endoscopic ultrasound and the MRCP, and if we find abnormalities that we are concerned could be precancerous, we then refer patients to a surgeon or medical oncologist,” Early says. “We’ve also decided to offer genetic counseling to all individuals who come into the program, and while not every person will be a candidate for genetic testing, it’s most appropriate to make that decision in conjunction with a genetic counselor.”

For those patients who are candidates for surgery, procedures like the Whipple procedure and new combination therapies have improved survival rates greatly over the past few years.

For example, Siteman surgeon David Linehan, MD, and his colleagues at Washington University published promising findings from a clinical study in the August 2008 Annals of Surgery. The results showed that patients who undergo the Whipple procedure – a large surgery where the cancer is removed in its entirety along with the duodenum and bile duct – in conjunction with other treatments have improved outcomes.

“We used a combination of surgery followed by radiation and immunotherapy as well as chemotherapy, and we saw improvement in three-year survival for patients who underwent the Whipple procedure,” Linehan says.

In general, mortality for the Whipple procedure has gone from 15 percent 25 years ago to about 1 percent today if done at a high-volume center like Siteman, where approximately 110 of the surgeries are performed annually.

Still, early diagnosis of pancreatic cancer remains key, and that’s why screening high-risk patients should prove beneficial. “I think it’s critically important in this disease if we’re going to make an impact,” Linehan says. “We have to diagnose it earlier when more patients are candidates for surgical treatment.”

For more information about the pancreatic cancer screening program, call 800-600-3606.