Disease screening is when an approach is employed to attempt an identification of a disease in an individual, prior to the presence of any diagnostic signs or symptoms of the disease (https://www.urmc.rochester.edu/Encyclopedia/Content.aspx?ContentTypeID=85&ContentID=P00965). Screening has been implemented for several cancers in the United States over the past few decades. For example, the colonoscopy for colorectal cancer and the mammogram for breast cancer. There is some controversy if the said screenings are responsible for the resulting decline in deaths from these specific cancers. Many cancers, including pancreatic cancer, have a better survival rate when able to be detected early (Poruk, Firpo, Adler, & Mulvihill, 2013).
The greatest odds of survival are when the tumor can be identified in a stage that it can be treated with surgical resection. However, only 10-20% of pancreatic cancer patients are currently being diagnosed at this stage (Poruk et al, 2013). The incidence and population mortality rate from pancreatic cancer are certainly large enough for the medical field to study screening. There is likely a significant time-period where pancreatic cancer can be discovered in an early and treatable stage. One study on cancer cells during autopsy of pancreatic cancer patients found an average of 11.7 years between tumor initiation and occurrence of cancer and 6.8 years between the development of cancer and metastasis of the disease (Poruk et al, 2013). Ideally, a screening test should apply to a general population of individuals. However, due to the low incidence of pancreatic cancer in the general population there would be a very low positive predictive value in the screening. This means there would be a very low assurance that someone with a positive screen would accurately be diagnosed with pancreatic cancer. This would cause a very large number of people to be false positive, which would lead to unnecessary and expensive invasive medical tests to confirm a diagnosis. With limited knowledge and current technology, it is almost impossible to have a screening test with 100% sensitivity and specificity (Poruk et al, 2013). Therefore, the population of people being screened would need to be narrowed down. This could be done by only screening people with known risk factors or one of the several genetic disorders which are known to increase the risk of pancreatic cancer. Current work on pancreatic cancer screening is looking at the use of several different biomarkers, the most well-known of them is CA 19-9. Several different biomarkers have been researched with CA 19-9 appearing to be the most accurate available tumor marker for pancreatic cancer, although it is found to only be about 80% accurate in identifying pancreatic cancer patients (http://www.pathology.jhu.edu/pc/BasicScreening.php?area=ba). The medical field is also working on advancing the use of the endoscopic ultrasound as a possible screening tool (http://www.pathology.jhu.edu/pc/BasicScreening.php?area=ba). A good screening tool should be inexpensive, safe and highly accurate. Sadly, there is not a test available for pancreatic cancer that meets these criteria. Although, the possibility is much greater than it was a decade ago due to more we have learned about the genetic tendency of the disease. It has only been in the past few decades that a link between genetics and pancreatic cancer was discovered. Researchers have found that people with abnormalities in certain genes may account for as much as 10% of known pancreatic cancer cases (4) Those with a history of familial pancreatitis, Peutz-Jehgers syndrome, Von Hippel-Lindau syndrome, Lynch syndrome and hereditary breast and ovarian cancer are all at a much higher risk for developing pancreatic cancer (http://www.pathology.jhu.edu/pc/BasicScreening.php?area=ba). Those with diabetes seem to be at higher risk, as pancreatic cancer is more prevalent in those diagnosed with type 2 diabetes. However, the reason for this has not been identified and is still being researched (4). …show more content…
One of these is diet and nutrition. It is thought that a high-fat diet that contains larger amounts of red and/or processed meats and low amounts of fruits and vegetables may contribute to pancreatic cancer (Dunphy, 2008) Also, a lack of physical activity may increase risk, but this may be because those with low activity are more likely to be obese, which is one of the known risk factors. Finally, increased coffee and alcohol have been suggested risk factors but the link has not been shown by reliable research studies
The greatest odds of survival are when the tumor can be identified in a stage that it can be treated with surgical resection. However, only 10-20% of pancreatic cancer patients are currently being diagnosed at this stage (Poruk et al, 2013). The incidence and population mortality rate from pancreatic cancer are certainly large enough for the medical field to study screening. There is likely a significant time-period where pancreatic cancer can be discovered in an early and treatable stage. One study on cancer cells during autopsy of pancreatic cancer patients found an average of 11.7 years between tumor initiation and occurrence of cancer and 6.8 years between the development of cancer and metastasis of the disease (Poruk et al, 2013). Ideally, a screening test should apply to a general population of individuals. However, due to the low incidence of pancreatic cancer in the general population there would be a very low positive predictive value in the screening. This means there would be a very low assurance that someone with a positive screen would accurately be diagnosed with pancreatic cancer. This would cause a very large number of people to be false positive, which would lead to unnecessary and expensive invasive medical tests to confirm a diagnosis. With limited knowledge and current technology, it is almost impossible to have a screening test with 100% sensitivity and specificity (Poruk et al, 2013). Therefore, the population of people being screened would need to be narrowed down. This could be done by only screening people with known risk factors or one of the several genetic disorders which are known to increase the risk of pancreatic cancer. Current work on pancreatic cancer screening is looking at the use of several different biomarkers, the most well-known of them is CA 19-9. Several different biomarkers have been researched with CA 19-9 appearing to be the most accurate available tumor marker for pancreatic cancer, although it is found to only be about 80% accurate in identifying pancreatic cancer patients (http://www.pathology.jhu.edu/pc/BasicScreening.php?area=ba). The medical field is also working on advancing the use of the endoscopic ultrasound as a possible screening tool (http://www.pathology.jhu.edu/pc/BasicScreening.php?area=ba). A good screening tool should be inexpensive, safe and highly accurate. Sadly, there is not a test available for pancreatic cancer that meets these criteria. Although, the possibility is much greater than it was a decade ago due to more we have learned about the genetic tendency of the disease. It has only been in the past few decades that a link between genetics and pancreatic cancer was discovered. Researchers have found that people with abnormalities in certain genes may account for as much as 10% of known pancreatic cancer cases (4) Those with a history of familial pancreatitis, Peutz-Jehgers syndrome, Von Hippel-Lindau syndrome, Lynch syndrome and hereditary breast and ovarian cancer are all at a much higher risk for developing pancreatic cancer (http://www.pathology.jhu.edu/pc/BasicScreening.php?area=ba). Those with diabetes seem to be at higher risk, as pancreatic cancer is more prevalent in those diagnosed with type 2 diabetes. However, the reason for this has not been identified and is still being researched (4). …show more content…
One of these is diet and nutrition. It is thought that a high-fat diet that contains larger amounts of red and/or processed meats and low amounts of fruits and vegetables may contribute to pancreatic cancer (Dunphy, 2008) Also, a lack of physical activity may increase risk, but this may be because those with low activity are more likely to be obese, which is one of the known risk factors. Finally, increased coffee and alcohol have been suggested risk factors but the link has not been shown by reliable research studies