Pancreatic cancer is the fourth leading cause of cancer death in the US, causing about 28,000 deaths every year. Because the early stages produce few or no symptoms, it is usually advanced when it is found. Most patients survive less than 12 months after diagnosis. In the past, there has been no way to detect pancreatic cancer in its earliest stages, when chances for a cure are highest.  Now, for people with a very strong family history of pancreatic cancer, help may be on the way.

 In a study published recently in the Annals of Internal Medicine (Vol. 131, Issue 4), Teresa Brentnall, MD, and her colleagues at the University of Washington in Seattle performed a series of tests on 14 members of high-risk families. The researchers found that two imaging tests paired together could identify pre-cancerous changes called dysplasia in the pancreas, allowing the doctors to stop the process by removing the pancreas.

The first test, endoscopic ultrasound (EUS), uses sound waves to produce images of the pancreatic ducts. In the second test, called endoscopic retrograde cholangiopancreatography (ERCP), contrast dye is injected into the pancreatic ducts before an x-ray is taken to detect irregularities in these ducts. Both tests also use a lighted tube passed down the throat that allows doctors to accurately place the ultrasound probe or reach the pancreatic ducts through their connections to the small intestine.

In 10 of the 14 patients tested, images from the first test -- the ultrasound -- showed abnormalities in pancreatic ducts, but could not distinguish them from non-cancerous changes caused by chronic irritation of the pancreas. Those 10 patients next underwent the more precise ERCP. In seven of the 10 patients, the ERCP also revealed changes, including tiny, grape-like clusters of sacs in some ducts, suggesting that dysplasia might be present.
 
Those seven patients chose to have their pancreases removed to eliminate the possibility of pancreatic cancer developing. In all seven, examination of the tissue under a microsope after the operation revealed pre-cancerous dysplasia.

Paul F. Engstrom, MD, vice president of population studies at Fox Chase Cancer Center and a member of the American Cancer Society (ACS) health content advisory group, called the new screening regimen promising, but cautioned that removal of the pancreas is not for everyone from a family with some pancreatic cancer in its history. "It leaves the patient diabetic, and there can be life-threatening complications from the surgery. One would have to have a very strong family history of pancreatic cancer to make such an operation even potentially worth the loss of the pancreas," he said.

"Also, we can't be sure that those seven patients would have developed pancreatic cancer from their dysplasia. And the patients who had negative results have not been followed long enough yet to know if they, too, might develop pancreatic cancer," Dr. Engstrom said.

Dr. Engstrom noted that diabetes can be controlled with medicine, and most diabetics live with the condition for many decades. In contrast, the five-year survival rate for people with pancreatic cancer is about 4 percent, he said.

Dr. Brentnall cautioned that the new screening regimen should only be done at major cancer centers where high levels of experience and technology can help ensure accurate results. "Ultimately, the goal is to develop specific tumor marker (blood) tests for pancreatic cancer," said Dr. Brentnall.  "But this is a huge step forward. We will continue to closely follow people whose test results were negative with additional periodic tests. We want to refine this tool and develop more and better tools."