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Pancreatic Cancer Screening for High-Risk Patients

Through advances in diagnostic screening, the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine is now offering pancreatic cancer screening for people at high risk for the disease.

“This screening program is important because the people who can get cured of pancreatic cancer are those in whom it’s found early and surgery is successful at removing the entire tumor,” says Dayna S. Early, MD, Washington University gastroenterologist at Barnes-Jewish.

The screening program involves two tests: endoscopic ultrasound and magnetic resonance cholangiopancreatography (MRCP), an MRI alternative to visualize the pancreas, biliary tract and pancreatic ducts.

Screening is encouraged for patients at high risk for pancreatic cancer and is not recommended for
the general population.

“We introduce people to the program through the endoscopic ultrasound and the MRCP, and only if we find abnormalities that we are concerned could be pre-cancerous would we then refer them to surgeons or medical oncologists,” says Early.

“We’ve also decided to offer genetic counseling to all individuals who come into the program, and while not every person will be a candidate for genetic testing, it’s most appropriate to make that decision in conjunction with a genetic counselor.”

For those patients who are candidates for surgery, procedures such as the Whipple procedure have improved survival rates greatly over the past few years.

For example, David C. Linehan, MD, and other Washington University physicians published in the August 2008 Annals of Surgery results of a clinical trial finding patients who undergo the Whipple procedure in conjunction with other treatments showed improved outcomes.

“We used a combination of surgery followed by radiation and immunotherapy as well as chemotherapy, and we saw improvement in three-year survival for patients who underwent the Whipple procedure,”
says Linehan, a pancreatic cancer surgeon at Siteman.

Mortality for the procedure has gone from 15 percent 25 years ago to about 1 percent today if done at a high-volume center such as the Siteman Cancer Center, where approximately 110 surgeries are performed annually.

Still, early diagnosis of pancreatic cancer remains key, and that’s why screening high-risk patients should prove beneficial.

“I think it’s critically important in this disease if we’re going to make an impact,” Linehan says.
“We have to diagnose it earlier when more patients are candidates for surgical treatment.”

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