Pancreatic cancer is a rare disease that accounts for only three percent of all cancers. In recent years, however, it seems like we are seeing this condition in headlines everywhere. Notable personalities like Aretha Franklin, Patrick Swayze, and Steve Jobs have died from it, and now Alex Trebek has announced his diagnosis. Five years ago, pancreatic cancer was the fourth-leading cause of cancer deaths in the United States. Now, its incidence in the country has crept upward by about 0.5 percent yearly for more than 10 years. Japan, France, and Taiwan have all shown a rapid increase as well.
What’s behind these trends?
Deaths caused by pancreatic cancer surpassed breast cancer a few years ago, and it is also projected to take the place of colon cancer as the second leading cause of cancer-related deaths in the U.S. around 2020. In some way, we can consider that as a good thing as it reflects advances in fighting other malignancies.
Multiple intersecting factors contribute to the rising incidence of pancreatic cancer in 2019. Better screening and treatment have meant that patients with other types of cancer – specifically prostate, colon, and breast cancer – are able to live longer. The bad news, innovations like immunotherapy have not worked well for pancreatic cancer. Along with liver cancer, the disease is causing an outsize and growing portion of cancer mortality.
However, the expanding caseload also reflects progress. New methods of higher-resolution imaging and examining biopsied tissue have helped doctors identify unidentified tumors that couldn’t have been seen or were labeled “of unknown origin.” Some of these tumors turn out to be pancreatic.
Other forces at work
The aging of our population also has a role to play: it’s pushing up the rates of many kinds of cancer. We accumulate more genetic errors the longer we live. These errors can cause tumors, and it doesn’t help that aging makes our DNA cleanup crew less effective. In the case of pancreatic cancer, patients are composed mostly of individuals between 55 and 84 years old.
Smokers are twice more likely to develop pancreatic cancer than nonsmokers. While it’s important to note that smoking has slumped in the U.S., we’ll have to wait another 30 or 40 years to see its corresponding drop in cancer rates. There was also a dramatic falloff in smoking in the U.S. that started in the 1970s that should decrease pancreatic cancer cases in the country. But sadly, a new villain on the block is making more people at risk: obesity and type 2 diabetes.
Rising rates of obesity
From 1990 to 2017, data from 195 countries revealed a 130 percent increase in pancreatic cancer cases. That’s from 195,000 cases in 1990 to a staggering 448,000 in 2017. Higher-income nations had the highest incidence of the deadly disease and the highest death rates. While many factors are at work, researchers believe that obesity and diabetes are driving these statistics.
Pancreatic cancer expert at the Texas MD Anderson Cancer Center, Robert A. Wolff, with more than 20 years of experience in treating the disease, says than an average patient of his has a body mass index between 30 and 35 (obesity is defined as 30 or more). He says patients also have prediabetes or diabetes, are taking a lipid-lowering agent, and are hypertensive. If they have a history of smoking, it was almost sure that they would develop pancreatic cancer.
Many forms of cancer are linked to obesity and type 2 diabetes. Among the suspected reasons: too much insulin, excess hormones, chronic low-level inflammation, metabolic abnormalities, and growth factors released by fat tissue. Doctors look for early signs of pancreatic cancer in the tissue or blood of adults age 50 and older who were newly diagnosed with diabetes. About one percent of such individuals will have the disease within three years, says Lola Rahib, a researcher at the Pancreatic Cancer Action Network.
Challenges in detection
Time and again, studies in the clinic and laboratory have uncovered features of pancreatic tumors that make them difficult to diagnose and treat. The pancreas is located deep within the body and not routinely scanned or imaged, allowing malignant cells to grow undetected for many years.
The goal is to find biomarkers that are accurate enough to prevent “emotional and costly” false positives and negatives. Otis Brawley, chief medical and scientific officer at the American Cancer Society, notes that the quest for liquid biopsies or cancer blood tests is one of the hottest areas in oncology, but there’s a long way to go. So far, the tests reported have unsatisfactory specificity.
If in the future scientists would be able to detect pancreatic cancer at an early stage, treatment should also progress significantly to do much good. Unlike many diseases that can be cured caught early, pancreatic tumors are quick to spread. Brawly describes the cells like “crumbling popcorn ball.” Still, we have seen modest advancements in the past years. Five-year survival rates for pancreatic cancer have improved from six to nine in recent years.
Our plan of attack
Advanced age is the number one risk factor for cancer in general, and pancreatic cancer is no exception. We can look at the aging population as a testament to the success of recent medical efforts in reducing mortality from many diseases. Meanwhile, there is a nationwide act to fight the obesity epidemic in the U.S. Furthermore, two new drugs were approved last year that could help some pancreatic cancer patients. Clinical trials are also looking at the best approaches to treat patients before and after surgery.
Scientists are hopeful that novel, precision medicine therapies will eventually aid patients, especially the 10 percent or so whose cancer is caused by heredity than their way of life. Surgical innovations and new drugs are more reasons to be hopeful. Wolff says that prevention is still the best thing you can do for yourself. It is believed that 30 percent of pancreatic cancer is preventable. Better diets, cutting the extra weight, no smoking, and more exercise are things that everyone should try.