Yesterday, a group of friends had a discussion on screening for pancreatic cancer. Pancreatic cancer is rare but, when discovered, is often advanced and has a very bad outcome. The United States Preventive Task Force recommends against screening asymptomatic individuals.
However, certain individuals have an elevated risk of pancreatic cancer and should have screening done. Most cancers of the pancreas are not based on genetic makeup. 10-15% of pancreatic cancers have a strong family history or identifiable mutations associated with increased risk. These include Peutz-Jeghers syndrome, BRAC2 mutations, hereditary pancreatitis, familial atypical mole melanoma, Lynch syndrome, and familial pancreatic cancer (two affected first-degree relatives).
The American Gastroenterological Association recommends screening certain high-risk individuals. This would include those genetic conditions I listed above. Screening can be accomplished with a specific MRI scan technique or an endoscopic ultrasound. CT scans can be used, but these scans are associated with unwanted radiation exposure.
A number of risk factors can be favorably impacted by lifestyle changes. These are familiar. Obesity, Type 2 diabetes, red meat consumption, smoking, and alcohol consumption all increase risk.
Another common concern is the discovery of pancreatic cysts when diagnostic tests are done for abdominal complaints or other reasons. Most cysts are benign, but some have malignant potential and require specific follow-up.
Specifically, Intraductal Papillary Mucinous Neoplasms (IPMN) have malignant potential. IPMNs of the main pancreatic duct have a 65% chance of developing into pancreatic cancer.
It is my belief that IPMNs should be followed at a center with special expertise in their management.