Pancreatic cancer screening has advanced significantly in recent years. There are now research-based guidelines on screening for people at high risk of developing the disease, and researchers are collaborating to develop new screening approaches involving genetic testing and artificial intelligence (AI).

"We have high-quality studies from the U.S. and Europe that show screening can detect cancer at an earlier stage and that detection leads to better overall outcomes — most notably, improved survival," says Michael Wallace, M.D., an interventional endoscopist at Mayo Clinic Comprehensive Cancer Center.

Here's what you need to know about pancreatic cancer screening:

Who should be screened for pancreatic cancer?

Guidelines recommend screening for people at high risk of pancreatic cancer — those with a family history of the disease or known genetic mutations.

People with a family history of pancreatic cancer have the highest risk of developing the disease. "The more relatives you have with pancreatic cancer, the greater your risk. Our threshold to recommend screening is two first-degree relatives (mother, father or siblings) or three relatives of any degree with pancreatic cancer," says Dr. Wallace.

It's also possible to have genetic mutations or changes that put you at high risk of pancreatic cancer, but Dr. Wallace says few people receive the genetic testing needed to identify those mutations. "Less than one-third of people who are eligible get genetic testing," he says. "It can be a lifesaving procedure that is available and covered by health insurance."

Mayo Clinic research has also shown that a new diagnosis of diabetes accompanied by weight loss can be one of the earliest indicators of pancreatic cancer. "This is different than the more common form of diabetes that is associated with obesity and weight gain. This is diabetes associated with weight loss, particularly in people over the age of 50. Those individuals should speak with their doctor and consider having an evaluation to look at their pancreas, such as imaging or blood tests," says Dr. Wallace.

How is pancreatic cancer screening conducted?

Dr. Wallace says two screening tests are recommended for pancreatic cancer: MRI and endoscopic ultrasound.

"Screening should be done in a center that can conduct a high-quality MRI and a procedure called an endoscopic ultrasound," says Dr. Wallace. "That's like the endoscopy we do for heartburn or stomach pain, but the endoscope has an ultrasound device on the end of it."

Because the pancreas sits just behind the stomach, an endoscopic ultrasound allows your doctor to get a precise view of the pancreas. If an area looks concerning, they can use the endoscope to get a biopsy.

Screening is generally recommended once a year. "In many cases, we alternate tests — an MRI one year and an endoscopic ultrasound the next year," says Dr. Wallace. He stresses the importance of getting screening from an experienced pancreatic cancer care professional. "Both tests are somewhat user dependent. That means the people performing the tests should be highly experienced in looking at the pancreas — professionals at a large academic medical center (one that educates healthcare professionals) that see lots of patients with pancreatic disease and pancreatic cancer."

What are the latest research advances in pancreatic cancer screening?

Genetic testing and screening

Efforts are underway to increase awareness and use of genetic testing, which is crucial for identifying and screening people at higher risk of pancreatic cancer.

People identified as high risk based on genetic testing make up only about 10% of pancreatic cancer diagnoses. Healthcare professionals often incidentally diagnose the other 90% of pancreatic cancer cases while investigating another issue, such as a pancreatic cyst. "A cyst is a small fluid collection. Most cysts are benign, but there is a small subset that can turn malignant," says Dr. Wallace.

Dr. Wallace and his colleagues around the world are working to establish screening tests to identify people in the 90% group. One test in development analyzes the fluid in pancreatic cysts to determine the risk of cancer. Another test analyzes pancreas juices for cancer risk.

Artificial intelligence for screening and classifying risk

Dr. Wallace says about 40% of people over the age of 50 have some type of pancreatic cyst. Understanding their pancreatic cancer risk is a key part of personalizing their screening plans to identify the disease earlier.

Dr. Wallace and his colleagues are nearing the end of a five-year study evaluating an AI algorithm designed to help care teams classify high- and low-risk cysts. Preliminary findings published in 2019 showed the algorithm could read an MRI scan in half a second, compared to 20 to 30 minutes of manual review by a radiologist. "These advances allow us to tell which of these cysts are likely to turn cancerous, and for those individuals, we can remove the cyst before it becomes malignant and prevent the disease," says Dr. Wallace.

This research, which is expected to conclude in 2025, has the potential to reduce the need for invasive biopsies, enhance screening program accuracy, and improve patient outcomes.

Collaborative research and future directions

In addition to the screening and early identification methods being evaluated at Mayo Clinic, researchers are focused on using indicators such as body weight, blood sugar and cholesterol to predict pancreatic cancer risk.

Dr. Wallace says these indicators might help suggest who could benefit from pancreatic cancer screening. "We're all getting our weight, sugars and cholesterol checked every year. Might there be a signal there that we could use to say you might consider getting screened for pancreatic cancer?"

The integration of genetic testing, AI and innovative screening technologies into preventive care offers the potential to identify pancreatic cancer at earlier, more treatable stages. "We're hoping to implement these advances to monitor patients and alert care professionals of pancreatic cancer risk," says Dr. Wallace. "I really want people to have a sense of hope for pancreatic cancer. We have made important improvements in overall survival and an overall shift towards early detection."

This story was originally published on the Mayo Clinic Comprehensive Cancer Center blog.

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