Pancreatic Cancer: Prevention and Genetics
PurpleStride Manhattan is a 1-, 2-, or 3-mile walk at Riverside Park to create awareness, raise funds and meet others who share the same goal: to find a cure for pancreatic cancer! The November 2009 walk included over 2000 participants and raised over $300,000 for pancreatic cancer research.
Understanding how cancers grow has made it possible to prevent many types of cancer. Tests such as mammograms, colonoscopy, and PSA tests can detect precancerous cells, which can be surgically removed before they progress to more harmful stages — thereby preventing thousands of people from developing more dangerous forms of breast, colon, and prostate cancer every year.
In the same way that colon cancer progresses through various stages of polyp formation, pancreatic cancer also includes stages of premalignant growth. If physicians can detect precancerous lesions and remove them, pancreatic cancer can sometimes be averted.
Yet unlike the breast, colon, or prostate, the pancreas is much more difficult to access, making testing more invasive and expensive. For that reason, screening for pancreatic cancer has never become routine. Instead, the disease has traditionally been detected only in its latest stages, when it is almost uniformly fatal.
But advances in understanding cell biology and genetics have led to the development of alternative methods of screening at The Muzzi Mirza Pancreatic Cancer Prevention & Genetics Program, a specialized center dedicated entirely to detecting and preventing pancreatic cancer. As described in a study of the center's results to date, screening with genetics and imaging can be highly effective in finding and curing premalignant and malignant pancreatic lesions.
According to Harold Frucht, MD, Program Director, "Research in the last few years has allowed us to better understand the progression of pancreatic cancer, so we better know who is at risk and what to look for. This allows us to carefully choose who to screen so that we don't do unnecessary testing or surgery."
In particular, recent research has shed light on multi-organ cancer syndromes that increase the risk of developing pancreatic cancer. These syndromes include:
- FAMMM, or Familial Atypical Multiple Mole Melanoma, which can be marked by the presence of moles on the body;
- Peutz-Jeghers syndrome, which is associated with gastrointestinal tumors;
- HNPCC, or hereditary nonpolyposis colorectal cancer (also called Lynch syndrome), which is associated with colorectal, endometrial, biliary, brain, and pancreatic cancers;
- Breast and ovarian cancer in association with the BRCA 1 or BRCA 2 genes; and
- Hereditary pancreatitis.
Even if a patient does not fit into one of the syndromes above, he or she may still have a family history of cancer that suggests higher risk for pancreatic cancer. Important signs of increased risk include early onset of cancers and multiple cancers (of any type) in the family. Ideally, people should seek screening at least ten years prior to the age at which their youngest relative with cancer was diagnosed.
How the Muzzi Mirza Pancreatic Cancer Prevention & Genetics Program Works
Anyone may request an appointment at the Muzzi Mirza center, including relatives of patients who have been diagnosed with pancreatic or other cancers. At the first appointment, the center takes a detailed family history and performs a physical exam. The family history is used to determine whether the patient's risk of developing pancreatic cancer is average, moderate, or high.
Blood tests may be administered to check for tumor markers, glucose levels (because many people predisposed to pancreatic cancer develop diabetes), and to assess liver function, pancreatic function, and other measures of health.
Some patients will undergo imaging tests such as CT scan, MRI, and endoscopic ultrasound of the pancreas. "Some patients have just blood work, others may have blood work and endoscopic ultrasound, others may have blood work and MRI, and still others may have all three," says Joanna Martinez-Gomez, Program Coordinator. "The higher the risk, the closer the look we need to take at the pancreas and the pancreatic ducts."
Genetic testing may also be recommended. "We are looking for any patterns of cancer, including breast, ovarian, colon, or others," says Dr. Frucht. "Certain syndromes predispose people to certain kinds of cancers. If we suspect that a syndrome may be present, we recommend genetic testing."
Depending on the results of these tests, the patient's risk level may be reclassified. The team then determines how often to monitor the patient. If an abnormality is found on imaging, the team decides whether to continue to monitor or to surgically remove it. Patients at high risk may return to the center at six or twelve month intervals for ongoing evaluation.
"For anyone with a family history of cancer, early screening is very important," says Kristin Engelstad, Genetics Counseling Intern in the Muzzi Mirza Program. "If there is cancer in your family – not just pancreatic, but any type of cancer – you can now be proactive rather than simply wait around to get cancer. If you wait until symptoms appear, often that is too late." She particularly encourages younger adults, who may resist the idea, to seek screening earlier rather than later. "Not only can it help in treating yourself, but if you have children, knowledge about a genetic mutation or syndrome can potentially help your children."
For information or to inquire about screening, visit www.pancreasmd.org or call 212.305.9337.