Signs of pancreatic cancer difficult to detect

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November 15, 2018 - 9:37 AM

Dear Dr. Roach: It is my understanding that there is no early-screening test for pancreatic cancer, and it is typically not diagnosed until it is very advanced, hence the high mortality rate.  My late loved one’s case was confirmed only after having a CT scan; not even an MRI revealed the tumors. A prominent person’s case was found early enough to be successfully treated only because she was a colon cancer survivor and a routine CT scan that was done as part of her follow-up revealed an early and treatable tumor in her pancreas. Why can’t CT scans be done routinely to check for pancreatic tumors? — S.C.

Answer: It’s a very good question, and one I am often asked, not only about cancer of the pancreas but also about ovarian cancer. The answer is that pancreatic cancer is uncommon (one to two people per 10,000 per year), and there are very few cases where the cancer can be found early enough to make a difference. Every study done so far on screening for pancreatic cancer has shown no reduction in the rate of death from pancreatic cancer. Even when found early by CT, ultrasound or blood testing, it usually is already too late for most. While I rejoice for Justice Ruth Bader Ginsburg, to whom I think you refer, she was one of the lucky few.

A reasonable follow-up might be: Even if screening only saves a few people, isn’t it worth doing? Unfortunately, there are downsides to screening. There are dollar costs of the tests. CT scans in particular have radiation, which if repeated, over time can increase the risk of developing other kinds of cancers. More importantly, scans can show findings that appear to be cancer or another abnormality, but on surgical biopsy turn out to be nothing important. This causes people to be operated on unnecessarily. So far, the harms of screening, even though they seem small, outweigh the much smaller chance of finding a curable cancer.

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