Although there are no screening tests currently available to screen the general population, investigators at Johns Hopkins are working on developing new tests such as the endoscopic ultrasound. It is hoped that these new tests may prove effective, particularly when applied to slect groups of patients known to have an increased risk of developing pancreatic cancer such as individuals with a strong family history of pancreatic cancer.
CA19-9 is the best available tumor marker for following the progression of the disease but is only 80% accurate in identifying patients with pancreatic cancer. Due to the inability of CA19-9 to identify early potentially curable disease, several other markers have been studied including SPAN-1, CA-50, DUPAN-2, elastase-1, tissue polypeptide antigen and tissue polypeptide-specific antigen. These markers have not performed nearly as well as the CA19-9.
An ideal pancreatic cancer screening test should be a safe, inexpensive, highly accurate test that reliably diagnoses pancreas cancer at a stage when it is not causing symptoms in the patient. This would provide that person the opportunity to take appropriate and effective action to treat and potentially cure the disease. Currently, we cannot offer a screening test for pancreas cancer that begins to meet these demands. However, the potential for screening this disease is considerably improved compared to just a few years ago.
First of all, we know more about which individuals have a genetic predisposition for developing this disease. Prior to the 1990's, it was not widely appreciated how often pancreas cancer is an inherited disease. Now we know that individuals with abnormalities in certain genes, such as BRCA2, p16, HNPCC, and individuals with histories of familial pancreatitis and Peutz-Jeghers syndrome are all predisposed to pancreatic cancer. These are important discoveries. However, individuals who inherit damage to one of these genes still represent only a modest proportion of all those individuals at risk of developing pancreatic cancer.
Secondly, we now know much more about the changes in the DNA and other molecules in the pancreas cells that give rise to pancreatic cancer. Most of these changes are not inherited and occur as the result of factors such as smoking, diet, and age. Importantly, pancreatic cancer researchers are characterizing these specific changes in DNA and other molecules. Armed with this knowledge, it is hoped that over the next few years, specific and extremely sensitive screening tests will be developed. Such a screening test will be able to detect pancreatic cancer at an early stage when it still cannot be visualized using state of the art diagnostic imaging techniques. Once such a screening panel is in place, it can be offered to individuals who, from their family history, know that they are at particular risk of developing this disease.
Because of the enormous need to develop a sensitive and specific screening text for early pancreatic cancer, we have a research laboratory at Johns Hopkins dedicated to finding new screening tests for pancreatic cancer. This lab is headed by Dr. Michael Goggins. You can find out more about this exciting lab here.