Who is at Risk? |
History & Physical Examination
Family History |
As physicians and patients become more aware of the importance of hereditary cancer
syndromes, more patients are surfacing who have multiple family members with pancreatic
cancer. Pancreatic cancer is clearly hereditary in at least 10% of cases; the risk of
pancreatic cancer is increased 3-fold if one first-degree relative is affected. Having
multiple affected members increases the risk even more, so that some family members have
a 50-50 chance of inheriting pancreatic cancer. How will we provide cancer surveillance
for these people who have family members who developed the disease?
Surveillance strategies are now unfolding. The goal of surveillance is to identify affected
patients before they develop invasive cancer but after dysplasia or pre-cancer has developed.
Timing is crucial for determining when a patient warrants surgery, if performed too early the
patient is put at risk for the morbidity and mortality of a total pancreatectomy, including
death and brittle diabetes1. The alternative of diagnosing too late leads to a patient with
Currently there are a few published studies examining the best modalities to evaluate patients
at increased risk for pancreatic cancer: one from our experience at the University of Washington
and one from John’s Hopkins. These reports include patients from multiple familial pancreatic
cancer kindreds. Use of endoscopic ultrasound (EUS) can be helpful for detecting early treatable
cancer and precancer in high risk patients (patients with a strong family history of pancreatic cancer).
Of note, however, is the fact that a small percentage of normal patients and patients who drink moderate
to large amounts of alcohol can also have EUS changes in the pancreas. Thus, while EUS can be valuable
for the early detection of cancer and pre-cancer in very high risk individuals, the results from the
study need to be interpreted by an expert and evaluated in light of the patient's history of alcohol use.