STEP 1: Prevention and early detection
This step outlines recommendations for the prevention and early detection of pancreatic cancer.
Evidence shows that not smoking, avoiding or limiting alcohol intake, eating a healthy diet, maintaining a healthy body weight, being physically active, being sun smart and avoiding exposure to oncoviruses or carcinogens may help reduce cancer risk (Cancer Council Australia 2018).
Although the aetiology of pancreatic cancer is unknown, the current prevention strategies involve reducing risk factors. The two most effective prevention strategies include avoiding tobacco smoking and maintaining a normal body weight (American Cancer Society 2019; Xu et al. 2018). Some studies suggest a change in diet may decrease the risk of pancreatic cancer by decreasing soft drink and sugar consumption and increasing consumption of whole grains and vegetables (Lei et al. 2016; Pericleous et al. 2014).
The risk factors for developing pancreatic cancer include:
- tobacco smoking (most established risk factor; risk increases significantly with greater intensity and duration) (Arriaga et al. 2019)
- cystic lesions of the pancreas
- obesity
- increased consumption of red meat and processed meat
- a family history of pancreatic cancer
- older age
- chronic pancreatitis
- longstanding type 2 diabetes mellitus
- male gender
- Asian or Pacific Islander ethnicity
- chronic alcohol consumption
- liver cirrhosis
- stomach infections with the bacterium Helicobacter pylori, which causes stomach ulcers
- heavy occupational exposure to certain pesticides, dyes and chemicals used in metal refining (Cancer Australia 2017a).
Having certain hereditary conditions also increase a person’s risk of pancreatic cancer:
- hereditary pancreatitis syndrome
- hereditary nonpolyposis colon cancer (HNPCC – Lynch syndrome)
- Peutz-Jeghers syndrome
- hereditary BRACA2-related breast and ovarian cancer syndrome
- familial atypical multiple mole melanoma (FAMMM) syndrome
- ataxia-telangiectasia syndrome (ATM mutation)
- Li-Fraumeni syndrome (TP53 mutation).
There is no recommended population screening program for pancreatic cancer in Australia.
The cancer antigen 19-9 (CA 19-9) tumour marker is not recommended as a population screening tool for pancreatic cancer due to the low sensitivity and specificity of the test, but rather it should be used as a marker of response to treatment (NCI 2019a).
For people with a strong family history of pancreatic cancer (those who have two or more close relatives affected by pancreatic cancer) and those with a family history of pancreatic cancer–related hereditary conditions (BRCA 2, Lynch syndrome, FAMMM syndrome and Peutz-Jeghers syndrome), it is recommended that they are referred to a familial cancer service, geneticist or oncologist for genetic testing (Goggins et al. 2019).
Potential imaging for monitoring pancreatic cancer in high-risk populations includes a range of imaging modalities; however, endoscopic ultrasound is generally accepted as the most sensitive imaging test for small pancreatic head tumours. Blood samples (CA 19-9, carcinoembryonic antigen [CEA] and liver biochemistry) are also collected.
