Screening for Pancreatic Cancer

         

May 18, 2009 — Pancreatic cancer is a deadly disease with a relatively poor prognosis. Screening for this cancer in high-risk individuals can lead to earlier detection and a better chance for a cure through surgery. Gastroenterologist Dayna Early, MD, discusses the benefits of pancreatic cancer screening, who is at high risk for the disease and what tests are used for early detection.

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TRANSCRIPT OF AUDIO FILE 

On this edition of Cancer Connection, we’ll talk about a new pancreatic cancer screening program, who is considered to be at high risk and the screening test physicians are using to detect the disease.

Host: Thanks for downloading this podcast from the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St Louis. I’m Jason Merrill. Depending on the situation, the prognosis for many pancreatic cancer patients is poor. For years physicians have sought ways to detect the cancer in its earliest stages, when patients have their best chance at survival. Through advances in diagnostic screening, the Siteman Cancer Center is now offering pancreatic cancer screening for people at high risk for the disease, and to tell us more is Dana Early. She is a Washington University gastroenterologist at Barnes-Jewish Hospital. Dr Early, thank you for joining us.

Early: Thank you, Jason. I’m happy to talk to you today.

Host: Often, pancreatic cancer is not diagnosed until it’s too late. So any news of a pancreatic cancer screening is certain to catch some attention. What is the goal of the program?

Early: We want to make people aware that we’re offering screening for patients who are at high risk for pancreatic cancer. Pancreatic cancer screening is not recommended for the general population, but there are people who are in high-risk categories that we think should be screened. We put together a program because we wanted to be able to offer screening here at the Siteman Cancer Center.

Host: Who would be identified as high-risk?

Early: Well, the most common group would probably be people with a family history of pancreatic cancer in two or more first-degree relatives. A first-degree relative is one of your parents, one of your own children or a brother or sister of yours. And there are other less common hereditary cancer syndromes like Peutz-Jeghers that put people at high risk for pancreatic cancer.

Host: And if somebody isn’t in that category, then what should they do?

Early: Well, we can certainly see them in consultation to determine what the best screening program is for them or even if they are candidates for a screening program. What we've done is develop a program that’s multidisciplinary. So we’re involving surgeons, medical oncologists, genetic counselors, gastroenterologists and radiologists so that we can offer patients the best care.

Host: What is involved in the screening?

Early: There are probably two types of screening that we’ll recommend, and most patients will probably get both. One is an endoscopic ultrasound, which is an endoscopic procedure where we look at the pancreas from the stomach and the duodenum. And the second procedure is an MRCP, which is a type of an MRI that also can look at the pancreas.

Host: This program is unique to the Siteman Cancer Center, but others do it. How successful have these program been in detecting pancreatic cancer early?

Early: Well, I would say very successful because of what you’ve just mentioned. When they do detect pancreatic cancers, they detect them early. Sometimes programs detect precancerous changes, and those oftentimes prompt a surgical resection. But then those patients are prevented from developing even early stage pancreatic cancer.

Host: It’s important to get screened early because pancreatic cancer is a pretty deadly disease, right?

Early: That’s right, and the people who can get cured are those where it’s found early and surgery is successful in removing the entire tumor.

Host: For people who do go on to surgery for pancreatic cancer, do they experience good outcomes?

Early: Generally, yes. Our center here is one of the highest-volume centers for doing Whipple procedures – a surgery to take out the head of the pancreas – and even distal pancreatectomy. So I would say in general the outcomes here are very good. Our surgeons here have worked over the years to perfect their techniques so that the complication rate is very low and patients do well postoperatively.

Host: If somebody is interested in getting involved in your screening program, how do they go about that?

Early: They can contact me directly, and we could get them into the program and determine whether or not they’re candidates for screening, and if so, what’s the best screening program for them.

Host: And it is multidisciplinary; it’s hitting many different areas.

Early: It certainly is. We would initiate people into the screening part, which would involve endoscopic ultrasound and the MRCP. And only if we detect abnormalities that we are very concerned about being precancerous would we then refer them to a surgeon or medical oncologist. We’ve decided that we’ll offer genetic counseling to all individuals who come into the program. Not everyone will be a candidate for genetic testing, but I think it’s most appropriate to make that decision in conjunction with a genetic counselor.

Host: Dr. Early, thank you for joining us.

Early: Thank you, Jason.

Host: For more information about the pancreatic cancer screening program, visit the Siteman Cancer Center online at www.siteman.wustl.edu or call 800-600-3606. Thanks for downloading. Until next time, I’m Jason Merrill.