Can You Screen for Early Pancreatic Cancer?

A: Pancreatic cancer is the fourth-leading cause of cancer death in the United States, claiming some 44,330 lives a year, but there is currently no standard screening test that can detect this cancer early and “has actually been proven to save lives,” said Dr. Otis Brawley, chief medical and scientific officer for the American Cancer Society.

Individuals with a strong family history of pancreatic cancer, such as having a parent, sibling or child who developed the cancer before turning 50 or two such close relatives who developed it at any age, are at increased risk of developing the disease themselves.

Certain genetic syndromes, like Lynch syndrome, which is associated with colorectal cancer, and mutations in the BRCA1 and BRCA2 genes, which are linked to increased breast and ovarian cancer risk, have also been linked to pancreatic cancer.

But while people who are at risk should be monitored, there is no medical consensus on the best way to do so.

Doctors may offer a blood test called a CA 19-9 radioimmunoassay to measure levels of a substance associated with pancreatic tumor cells, but the test is problematic because noncancerous conditions can also cause CA 19-9 levels to rise, and not every patient with cancer will have an elevated level.

Doctors may also offer people at risk a CT or other type of scan that focuses on the pancreas, but these tests have not been proven effective at picking up small early stage cancers or precancers, and they expose patients to large amounts of radiation, Brawley said.

“There are anecdotal reports of people who know they have pancreatic cancer in the family who got one or both of these tests and found what appeared to be a localized pancreatic cancer, and some of these people have gotten surgery and done very well,” Brawley said. “But doctors like me are unable to say whether they would have done well without the screening. We just can’t say one way or the other.”

He cautioned that “the harms associated with both these tests are so severe that really only people who are at high risk ought to be getting them, if they should be getting them.”

Symptoms of pancreatic cancer include jaundice, or yellowing of the eyes and skin, dark urine, itchy skin, belly pain or back pain, weight loss, poor appetite, nausea and vomiting, enlargement of the liver or gallbladder and blood clots.

Some lifestyle habits — like smoking and obesity — are associated with pancreatic cancer, so quitting tobacco and keeping weight down may reduce the risk.

Workplace exposure to chemicals used in the dry cleaning and metal working industries also increases risk, and people with Type 2 diabetes and some other conditions, like chronic pancreatitis and cirrhosis of the liver, are at increased risk as well.

African-Americans are slightly more likely to develop pancreatic cancer than whites, and men are slightly more likely to develop it than women.