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Letter to the Editor – July 19th

5 mins read

Dear Friends and Neighbors:

I have pancreatic cancer, an unwanted surprise, as you can imagine. I am among the one in 67 women and one in 65 men, most often over the age of 55, to receive this diagnosis during a lifetime, based on National Institutes of Health statistics. Although pancreatic cancer is less frequent than other common cancers like lung, breast, prostrate, and colon, it has a terrible 5-year survival rate of 8 percent (American Cancer Society statistics, 2013). What is the explanation for this seeming disparity?

The number of people who smoke has decreased dramatically in recent decades, largely preventing new cases of lung cancer. Screening for breast cancer with mammography, for prostate cancer with “PSA” (prostate-specific antigen) blood tests, and for colon cancer with colonoscopy has led to earlier cancer detection and treatment and therefore to better chances for not just survival but also for a cancer-free future.

We don’t really know what the risk factors are for pancreatic cancer, although the usual suspects are noted: smoking, obesity, drinking too much, recent onset diabetes, family history. I have none of these risk factors. So at this moment we can’t prevent pancreatic cancer.

The symptoms, if you have any, are nondescript: new onset nausea, vomiting, yellow skin, yellow whites of the eyes, back or stomach pain, dark urine, chalk-colored bowel movements. I had all but the back and stomach pain, but my doctor apparently didn’t see a connection to the urgent diagnosis of pancreatic cancer since he couldn’t see me in his office for another two months. I did not receive a call back. So I took myself to the emergency department, because I’m a doctor and understood the significance of these symptoms. There blood tests and a CT (computerized tomography) scan were performed and I was immediately diagnosed. I was lucky I had symptoms; some people with pancreatic cancer do not.

There is no routine screening for pancreatic cancer despite the fact that several common blood tests – including LDH (lactic acid dehydrogenase) and ALP (alkaline phosphatase) – and one special order blood test – CA19-9 (cancer antigen 19-9) – are usually, but not always high or elevated, in pancreatic cancer. LDH and ALP have been tested separately and together as a screening tool for pancreatic cancer, as have other novel tests like CA19-9, but in 2004 the U.S. Preventative Services recommended against routine screening using any test for pancreatic cancer. There has been a lot of research since then, and the 2004 recommendation has been under evaluation since 2014.  

There is a test, a CT scan with contrast of the abdomen, that can “see” a pancreatic mass, which would then prompt further diagnostic testing and treatment.  Here in Beaufort it costs $495. The recommendations from 2004 do not recommend this for routine screening because it would cost more than $44,000 to find one case of pancreatic cancer. My treatment has cost far more that that, and I’m not finished yet. Early diagnosis might have reduced expenses and wear and tear on my body.

So here are my recommendations to you: You are your own best advocate. If you are older than 55 with new onset nausea, vomiting, diabetes, back or stomach pain, dark urine, pale bowel movements, don’t just call your doctor. Ask her or him if you should be screened for pancreatic cancer. If you are going for a yearly check-up, ask if you should be screened for pancreatic cancer. 

Here are my recommendations for researchers and the U.S. Preventative Services: For patients 55 or older, study whether a combination of all three blood tests (LDH, alkaline ALP, and CA19-9), and whether routine CT scans at yearly physical examinations, would provide a valid screening tool. Or any other combination of tests. We should be able to do what we have done for breast, prostate, lung, and colon cancer.

And for family doctors and internists: Sure, in someone with new onset nausea, there might be a new relatively benign disease like gastro-esophageal reflux disorder, but there could be something more urgent and sinister like pancreatic cancer.

For more information on pancreatic cancer, please go to www.pancreasfoundation.org

With you in health advocacy, 
Barbara Warner

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