How Trends in Pancreatic Cancer Risk & Diagnosis Can Shape Patient Care

November is Pancreatic Cancer Awareness Month, highlighting the need for communication around this disease. Over the last decade, changes in the incidence of pancreatic cancer have reshaped priorities for patient education on screening, risk, treatment options, and outcomes. Between 2010 and 2019, pancreatic cancer cases have risen at an average rate of 0.5% each year, representing about 3% of all new cancer cases in the United States.¹ While overall more common in men and older adults, there has been a greater relative increase in cases among women under 55 years old.² With cases increasing, it’s more important than ever for patients across demographics to learn about pancreatic cancer risk and take appropriate action.

Helping patients understand their pancreatic cancer risk

Because pancreatic cancer has few observable symptoms until it has progressed, it’s critical for patients to be proactive. Roughly 1 in 64 American adults will be diagnosed with pancreatic cancer during their lifetime, but this rate is highly dependent on different risk factors. Patients need to understand the distinct risk factors that are within their control in order to make proactive behavioral changes. Some factors to consider include:

• Tobacco use - Smokers face approximately twice the risk of pancreatic cancer incidence compared to never smokers. However, a person’s risk of developing pancreatic cancer does decrease upon quitting, offering a hopeful approach for current smokers.
• Diet and body weight - Individuals with a body mass index (BMI) of 30 or higher are about 20% more likely to develop pancreatic cancer, and weight gain during adulthood is particularly impactful.³ Additionally, high consumption of red and processed meats, saturated fats, and cholesterol may be associated with an increased risk of pancreatic cancer.⁴
• Heavy alcohol consumption - While research on the subject has found inconsistent results, there does appear to be a link between heavy drinking and pancreatic cancer risk, particularly among smokers.⁵ This relationship is largely associated with an increased risk of chronic pancreatitis among heavy drinkers.

Understanding risk factors outside of patients’ control can also be important to motivate proactive screening efforts and health-promoting behaviors. Some of these factors include:

• Age - The average age at time of a pancreatic cancer diagnosis is 70 years old, with the vast majority of patients over the age of 45.³
• Race - The incidence of pancreatic cancer in the U.S. is higher among Black Americans than any other racial or ethnic group, with Black patients also being diagnosed later and having higher mortality rates compared to other patient groups.⁶ This disproportionate burden is associated with a host of other health disparities, illustrating the need for wider efforts in bridging these care gaps.
• Familial history - A familial history of pancreatic cancer is among the most impactful risk factors for developing the disease. Having 2 first-degree relatives diagnosed increases one’s lifetime risk more than 6-fold, while 3 or more first-degree relatives confer a 32-fold increase in risk.⁷

Empowering patients to take proactive action because it lacks distinctive symptoms, early detection of pancreatic cancer is challenging. But by staying abreast of health changes and pursuing risk-appropriate screening measures, patients can be more likely to catch a diagnosis in earlier stages and have better outcomes overall.

While there are no screening guidelines in place for patients at average risk of pancreatic cancer, options are available for those at higher risk. Genetic testing is a valuable approach for assessing patient risk, especially among those with family history of pancreatic cancer. Many insurance plans cover such testing, and independent testing and genetic counseling services are becoming increasingly available for patients in health systems without access to such services.

Additionally, patients without insurance coverage for genetic testing or further screening procedures may be able to find access through clinical trials or public health pilot programs. Patients can explore options through resources on ClinicalTrials.gov or organizations such as the Pancreatic Cancer Action Network.

The value of screening for high-risk patients

For patients with known genetic susceptibility to pancreatic cancer, American Society for Gastrointestinal Endoscopy (ASGE) guidelines recommend annual screening with endoscopic ultrasound (EUS) and/or MRI. Many patients find these procedures daunting but understanding the benefits of proactive screening and establishing a routine screening plan can help to assuage their fears.

For example, a 2015 study of 140 high-risk individuals undergoing regular pancreatic cancer screening with MRI and EUS found that only 10% and 11% of patients, respectively, experienced discomfort with these methods. Patients also felt significantly less hesitation towards EUS procedures as surveillance progressed, and cancer worries decreased significantly over time.⁸ In short, pursuing a complementary EUS/MRI annual screening protocol imposes a low psychological burden on patients and may even be beneficial in reducing cancer worry. Particularly with invasive and often unfamiliar procedures such as EUS and EUS with fine needle aspiration (FNA), patients may not fully grasp how essential these tests are in detecting and evaluating potential pancreatic lesions. Having realistic and intentional discussions about the rationale, risks, and benefits of these procedures can be a valuable investment in patient care.

Take charge against pancreatic cancer

It’s easy for patients to be worried about pancreatic cancer but arming them with knowledge about risk factors and screening opportunities can motivate healthy behavioral change and help catch potential cases early. In honor of Pancreatic Cancer Awareness Month, engage and empower patients to be vigilant in facing this disease– their lives may depend on it.

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<sub>References
1. https://seer.cancer.gov/statfacts/html/pancreas.html
2. Gaddam S, Abboud Y, Oh J, et al. Incidence of Pancreatic Cancer by Age and Sex in the US, 2000-2018. JAMA. 2021;326(20):2075–2077. doi:10.1001/jama.2021.18859
3. https://www.cancer.org/cancer/pancreatic-cancer/causes-risks-prevention/risk-factors.html
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5. Rahman F, Cotterchio M, Cleary SP, Gallinger S. Association between alcohol consumption and pancreatic cancer risk: a case-control study. PLoS One. 2015 Apr 9;10(4):e0124489. doi: 10.1371/journal.pone.0124489. PMID: 25856529; PMCID: PMC4391718.
6. https://pathology.jhu.edu/pancreas/familial/about/african-americans
7. Aslanian HR, Lee JH, Canto MI. AGA Clinical Practice Update on Pancreas Cancer Screening in High-Risk Individuals: Expert Review. Gastroenterology. 2020 Jul;159(1):358-362. doi: 10.1053/j.gastro.2020.03.088. Epub 2020 May 19. PMID: 32416142.
8. Konings IC, Sidharta GN, Harinck F, Aalfs CM, Poley JW, Kieffer JM, Kuenen MA, Smets EM, Wagner A, van Hooft JE, van Rens A, Fockens P, Bruno MJ, Bleiker EM. Repeated participation in pancreatic cancer surveillance by high-risk individuals imposes low psychological burden. Psychooncology. 2016 Aug;25(8):971-8. doi: 10.1002/pon.4047. Epub 2015 Dec 3. PMID: 26632416.
All reference links:
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4391718/
https://www.giboardreview.com/wp-content/uploads/2020/12/Guidelines-AGA-pancreas-cancer-screening-Jul-2020.pdf
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