Screening for Pancreatic Cancer

While pancreatic cancer is a rare form of cancer, it’s also a very detrimental one. This cancer only has a 10% five-year survival rate. Its poor prognosis is thought to be due to its aggressive nature, advanced stage at the time of diagnosis and poor response to available therapies.

It’s important to understand the risks for pancreatic cancer, including the potential for genetic predisposition. Dr. Constantine Melitas, advanced therapeutic endoscopist and gastroenterologist for Dignity Health, shares important information about this often fatal disease.

Who Should Get Screened?

Pancreatic cancer affects 1.6% of the general population, making it a rare form of cancer. With that being the case, it’s a cancer that isn’t often screened for.

“Currently, there are no pancreatic cancer screening guidelines for the general population. However, there are some guidelines that recommend screening for certain patient populations which are at high risk for developing pancreatic cancer. There are a multitude of genetic diseases and findings, as well as syndromes, that put certain patients at a higher risk,” said Dr. Melitas.

Patients who meet criteria for pancreatic cancer screening are those who have a family history of pancreatic cancer, which includes two first-degree relatives with pancreatic cancer—meaning a mother, father, or sibling. Other considerations that would qualify a person for pancreatic cancer screening include Lynch syndrome, PALB2 mutations, and BRCA1 and BRCA2 mutations.

“A lot of people think of BRCA mutations being associated with gynecologic cancers like breast cancer and uterine cancer. However, there is a pretty significant risk of developing pancreatic cancer as well,” explains Dr. Melitas. “So much, in fact, that the most updated guidelines recommend anybody with a BRCA mutation should undergo pancreatic cancer screening.”

Previous guidelines mentioned that only BRCA patients with a family history of pancreatic cancer should undergo screening. However, studies have shown there is up to an 8% lifetime risk with BRCA mutation alone, regardless of family history. Therefore, the guidelines have since been updated.

Pancreatic Cancer Screening Modalities

As with other cancer screenings, the goal is to catch an abnormality early enough to effectively treat the disease and improve survival rates. “By doing this, patients who meet criteria for a pancreatic cancer screening program can get screened early and hopefully cure this detrimental and lethal condition,” notes Dr. Melitas.

There are currently two screening modalities. One is an endoscopic ultrasound, which requires an upper endoscope with an ultrasound probe at the end to be passed down the esophagus into the stomach. With the ultrasound, gastroenterologists are able to see through the stomach and get the most detailed picture of the pancreas. The benefit of this procedure is that a biopsy of any irregular-appearing portions of the pancreas can be done at that time.

“It is a bit more invasive than the other modality, which is MRI. But, it’s also more detailed,” shares Dr. Melitas. “What studies have shown, when comparing endoscopic ultrasound versus MRI head to head, endoscopic ultrasound was the modality that found the very small, very early pancreatic cancers under a centimeter, more so than MRI.”

First-Class Care at Dignity Health

Individuals who meet the criteria for pancreatic cancer screening have options at Mission Hope Cancer Center and Marian Regional Medical Center. The facility offers both endoscopic ultrasound and MRI screening capabilities. Patients benefit from multiple specialties in one place.

“We're fortunate to have amazing staff, support, and resources to make a significant impact on the community by developing only the second official pancreatic cancer screening program in the state,” says Dr. Melitas. “Individuals can contact us directly, and we can facilitate and screen them to see if they're somebody who would meet criteria for pancreatic cancer screening. However, we also have an algorithm through a lot of primary care offices, through oncologists and other general gastroenterologists, who can help us filter and find patients who may need screening.”

For more information about Dr. Melitas and our team of advanced endoscopists, please visit dignityhealth.org/phc, click on services and then on Gastroenterology Advanced Endoscopy.  To learn more about cancer services offered at our Dignity Health Central Coast hospitals and care centers, click here.