Are Women At Risk of Pancreatic Cancer?

Patrick Swayze famously lost the battle to pancreatic cancer in 2009. However, the disease doesn’t just strike men – women are at risk too. Research has answers to 8 common questions about the disease… How common is pancreatic cancer? Pancreatic cancer is rare, striking 5 out of every 100,000 annually or about 42,000 Americans, according to the American Cancer Society. It occurs nearly twice as often in men as women, but pancreatic cancer is still the fifth leading cause of cancer death for women in the U.S. It’s the fourth leading cause of cancer death for men. Because pancreatic cancer is hard to diagnose and treat, the mortality rate is high. About 35,000 Americans die from the disease every year. Research shows the average person has a 1% chance of getting pancreatic cancer, says Robert McWilliams, M.D., an oncologist at the Mayo Clinic in Rochester, Minn. That risk doubles to 2% if someone in the family has the condition. As the baby boomer generation nears retirement age, the number of people afflicted with pancreatic cancer is expected to rise. Overall though, pancreatic cancer tends to strike the elderly. Most are just over 70 years of age when diagnosed. Only 20% are under 60. What causes pancreatic cancer? Like other forms of cancer, pancreatic cancer is caused by mutations in DNA. Genetics, a poor diet and/or smoking may play a role in triggering the mutations. It typically starts in the tissues of the pancreas but may spread to the liver, lymph nodes and other surrounding areas. As many as 20 different tumors have been found to grow on and around the pancreas. Each is different and may require different treatment. Where is the pancreas and what does it do? Your pancreas is the large organ behind the lower part of the stomach. It secretes enzymes that aid digestion and hormones that help regulate sugar metabolism. “The pancreas is the geographic center of your body,” says Scott Kern, Ph.D., an associate professor of oncology and pathology and pancreatic cancer researcher at the Sol Goldman Pancreatic Cancer Research at Johns Hopkins in Baltimore, Md. “You can’t see it, you can’t feel it, and normal secretions can’t be seen without special equipment.” What are the symptoms of pancreatic cancer? Unfortunately, symptoms usually don’t appear until the disease is advanced, McWilliams says. That’s mainly due to the pancreas’ hidden location and behind-the-scenes role in bodily functions. When symptoms do surface, they include: Upper abdominal pain Loss of appetite Weight loss Depression What are the risk factors? Researchers know this much: Men and women are at equal risk for pancreatic cancer. But certain factors could put you at increased risk: Smoking Obesity Family history of multiple pancreatic cancers Diet high in animal fat History of chronic inflammation of the pancreas (pancreatitis) Smoking accounts for 25%-30% of pancreatic cancers. Cigarettes – or any burning tobacco product – release a chemical that can cause healthy cells to turn cancerous, according to an International Journal of Cancer study. Several studies show that obesity can raise the risk of pancreatic cancer by as much as 60%. A study conducted by the Women’s Health Initiative reported that obese people – those with a body-mass index over 30 – have increased levels of insulin, which may cause the disease. In particular, abdominal fat can raise your risk, says Rachel Stolzenberg-Solomon, M.D., a researcher at the National Cancer Institute’s Division of Cancer Epidemiology and Genetics in Bethesda. A British Journal of Cancer study reported that obese women who carry most of their weight around their belly are 70% more likely to develop the disease than those whose weight is more evenly distributed. Also, certain genetic illnesses can predispose someone to pancreatic cancer, including BRCA 2 gene mutation, Peutz-Jeghers syndrome, Lynch syndrome and familial atypical mole-malignant melanoma (FAMMM). The common connection is that these are hereditary syndromes. Researchers believe that the genetic mutations behind these conditions is linked to those that cause pancreatic cancer. But “these conditions are, fortunately, uncommon,” Kern says. Other potential risk factors for pancreatic cancer are maddeningly uncertain. Eating a diet rich in animal fat, eating charred meat and having type 2 diabetes all have been linked to an increased risk of the disease. For example, a 2009 study by the National Cancer Institute found that people whose fat intake – particularly from animal sources - ranged from 20%-40% saw an increased risk by as much as 36% But why these factors increase the risk of pancreatic cancer are unknown to researchers. And the risk is never zero for anyone. “Healthy people can get pancreatic cancer - including the ones who do everything right,” Kern says. How is pancreatic cancer diagnosed? No standard screening exists for pancreatic cancer. If a doctor suspects the disease, he or she may use the following tests: Magnetic resonance imaging (MRI): Like a CT scan, MRIs produces cross-sectional images of the body that are used to spot tumors. Ultrasound: Sound waves bounce off the pancreas to produce images of tumors. Computerized tomography (CT) scan: This X-ray produces images of tumors and can help diagnose the stage of the disease. Endocscopic retrograde cholangiopancreatography (ERCP): A thin, flexible tube is passed down the throat into the small intestine. It allows doctors to spot blockages of the bile and pancreatic ducts. Once a cancer diagnosis is confirmed, a doctor will determine the stage of the disease and create an appropriate treatment plan. What are the typical treatment options? Surgery is the most effective treatment for pancreatic cancer. However, only 15% of patients are diagnosed when surgery is still an option, McWilliams says. For the majority of people, by the time the disease is discovered, it’s too far advanced for surgery to be effective. Unlike breast cancer therapy, pancreatic cancer researchers have not yet developed a targeted treatment that can isolate and destroy pancreatic cancer cells. The problem: It’s a particularly aggressive cancer and moves swiftly. It’s an understudied disease, McWilliams says, mainly because survival is so short. “It’s hard to recruit people for [the length of] the study,” he adds. Most sufferers can be helped temporarily through radiation and chemotherapy treatment, as Swayze underwent. But these treatments do not, on average, change the survival time by more than a month or two, Kern says. That’s because there’s an intense cellular reaction around the tumor, making the cells more resistant to treatment than other cancers. That's why some patients decide to avoid the harmful effects of radiation and chemotherapy and choose not to have any treatment at all, McWilliams says. For people with a history of pancreatic cancer in the family, Kern says researchers are working on ways to identify the disease or precursors to the condition in its earliest stages, before someone develops symptoms. What’s the prognosis for recovery? Sadly, the survival rate for pancreatic cancer is low. It depends on the stage at which the cancer was found and whether the tumor is operable. Here is a breakdown of median survival rates: For those who undergo surgery (cancer is confined to the pancreas and the tumors can be removed): About 1-1/2 to 2 years. For locally advanced cancer (the tumor can’t be removed with surgery because the cancer has spread to tissue around the pancreas or into the blood vessels): 9-10 months. For stage IV, the most advanced stage (where cancer has spread far beyond the pancreas to the liver, lungs and lining that surrounds the abdominal organs): 5-6 months. That said, “some lucky patients have forms of pancreatic tumors that are curable with surgery,” Kern says. Still, if found early enough and treated with chemotherapy and surgery, the five-year survival outlook increases 17%-25%. For more information, visit our Cancer Health Center. What Really Causes Cancer? 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