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Pancreatic Cancer Risk Management

As part of Penn Medicine’s Gastrointestinal Cancer Genetics Program, the Pancreatic Cancer Risk Management Program is designed for individuals who are at increased risk of pancreatic cancer. This program provides comprehensive evaluation with genetic testing (if applicable), development of a pancreatic cancer screening plan, and ongoing follow-up care.

Why is early detection important in pancreatic cancer?

Pancreatic cancer is being diagnosed more frequently, with the average person currently having an approximately 1.5 percent lifetime chance of developing pancreatic cancer. Unfortunately, survival after diagnosis remains poor, with less than 10 percent of individuals with pancreatic cancer living five years after detection of the disease.

To date, the only potentially curative treatment for pancreatic cancer is surgery. Survival from pancreatic cancer is significantly higher when it is found at an early stage that can be treated with surgery, making early detection of pancreatic cancer very important.

Who should consider genetic testing for pancreatic risk?

Approximately 10 percent of pancreatic cancer is considered hereditary. Only a minority of individuals with hereditary pancreatic cancer will have a detectable hereditary mutation in a gene known to increase pancreatic cancer risk, whereas the majority of individuals with hereditary pancreatic cancer will not have a known gene mutation in the family.

Genetic testing is an available option for all people with a diagnosis of pancreatic cancer, for certain people with a strong family history of pancreatic cancer, and for people who have a family history of a known gene mutation that increases pancreatic cancer risk.

Who should be screened for pancreatic cancer?

At this time, pancreatic cancer screening is not recommended for the general, average-risk population. Groups who should consider pancreatic cancer screening include those with at least a five percent lifetime risk of developing pancreatic cancer (the age to start screening will depend on the family history):

  • Familial pancreatic cancer: Having two relatives with pancreatic cancer on the same side of the family. At least one should be a first-degree relative (parent, sibling, child) with pancreatic cancer, with this person also having at least one first-degree relative (parent, sibling, child) with pancreatic cancer
  • Genetic risk: Having a gene mutation in BRCA1, BRCA2, ATM, PALB2, or any of the Lynch syndrome genes (MLH1, MSH2, MSH6, PMS2, EPCAM), in addition to a first-degree relative (parent, sibling, child) or second-degree relative (grandparent, aunt/uncle, grandchild) with pancreatic cancer
  • Peutz-Jeghers syndrome (STK11 gene mutation)
  • Familial atypical multiple mole melanoma (FAMMM) syndrome (CDKN2A gene mutation)
  • Hereditary pancreatitis

The goal of screening is to identify pancreatic cancer at earlier stages, when surgery may be an option to help improve overall survival from the disease. Early data from research on this topic is promising, although more studies are still needed.

Furthermore, at this time it remains unclear how much individuals at increased risk for pancreatic cancer (the groups listed above) will benefit from pancreatic cancer screening. It is also unclear if other individuals (outside the groups listed above) will benefit from pancreatic cancer screening, such as those having a mutation in BRCA1, BRCA2, ATM, PALB2, or any of the Lynch syndrome genes (MLH1, MSH2, MSH6, PMS2, EPCAM) who do not have a family history of pancreatic cancer.

What does pancreatic cancer screening involve?

Pancreatic cancer screening typically involves annual imaging of the pancreas. Imaging tests may include: endoscopic ultrasound, MRI of the pancreas, or CT scan of the pancreas.

Currently, it is not known which type of imaging test is best, and it is also uncertain how often these imaging tests should ideally occur; however, current research is ongoing to better understand these questions. A personalized pancreatic cancer screening program may also involve annual blood work, since there are also ongoing studies looking at the role of blood tests for the early diagnosis of pancreatic cancer.

Pancreatic Cancer Risk Management

Under the direction of Bryson Katona, MD, PhD, Penn Medicine's Gastrointestinal Cancer Genetics Program has multiple ongoing pancreatic cancer early detection studies.