Screening for Pancreatic Cancer

Daniel Chung, MD, is a gastroenterologist in the Division of Gastroenterology at Massachusetts General Hospital, and the medical co-director of the Center for Cancer Risk Analysis in the Mass General Cancer Center. In this video, he discusses his work on pancreatic cancer screening and innovative ways to identify the people who are at the highest risk of this preventable disease.

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Transcript

We are also very, very interested in pancreatic cancer screening. We now have begun to recognize that pancreatic cancer does have a genetic component and that there are certain individuals who do have genetic risk factors for the disease. So as part of our program, we certainly do offer genetic testing to all patients with pancreatic cancer.

Currently, the field of pancreatic cancer screening is in its infancy, and the techniques that we use now have not been formally validated. Currently, we use endoscopic ultrasound and magnetic resonance imaging(MRI)/magnetic resonance cholangiopancreatography to screen individuals at high risk. We now have a protocol to study these particular techniques to understand how effective they are at identifying precancerous lesions as well as early pancreatic cancers. Data has finally emerged that using strategies such as endoscopic ultrasound and MRI that earlier stage lesions can be detected when they are more likely to be resectable.

We do think that the needle can be pushed even further forward, because I don't think that we have fully identified the best ways to identify precursor lesions. In many ways, our goal is not so much to identify cancer early, but really if we can identify the lesions that are precursors to cancer, we think we can prevent the disease altogether. This will rely not just on imaging techniques and refining those imaging techniques, but really taking advantage of thinking about new molecular approaches for diagnosis, looking at things like the microbiome (which is another area that we were very interested in) and looking at whether there are any other kind of new markers that can help us identify who are the people at highest risk.

By being able to accurately create risk assessment and really targeting some of these techniques to those who truly are at the highest risk, we think we can probably get the most bang for the buck. So we'd like to be able to have screening be part of the basic vocabulary for all patients and their providers. That routine early detection and preventive care is really, I think, an important part of what we should be doing us as physicians and clinicians. It is often hard to convince people to do things when they feel well; however, that is the time at which we can probably have the biggest impact on the natural history of a number of these preventable diseases.

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