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>> We do and we don't.
We know a lot more than we used to.
We know that pancreatic cancer runs in families often
because family members have a defective gene
that they passed on to other family members.
And we know this, for example,
if we take the Angelina Jolie BRCA gene,
we know that BRCA gene mutations
can cause pancreatic cancer to run in families,
much like it can cause breast and ovarian cancer,
and there are a number of other genes
like the BRCA gene that are also responsible
for causing pancreatic cancer.
There's a lot of effort underway to try and understand
all of the genes responsible
for a family developing pancreatic cancer.
But there's still a lot we don't know
and we can't forget as well that the same reasons
that cause the disease to run in people
when where it doesn't run in families,
such as smoking and lifestyle and environment and exercise,
these are probably also important factors
in families, as well.
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The question of genetic test comes up a lot
and we hear about it a lot in the news
and it is an important question.
And we do recommend genetic testing for some people
who have pancreatic cancer that runs in their families.
We don't offer it to everyone,
the reason is because we have to consider
how likely it is we're gonna find useful information
that's going to help our patients.
So, if we find families have multiple affected individuals
with pancreatic cancer,
what we do is we like them to see a genetic counselor
and/or a physician with expertise in guiding a patient
through the genetic counseling process,
understanding the kind of result that they might have,
because it has implications for family members.
Currently, we understand some of the genetics
of familial pancreatic cancer,
but there's still a lot we don't know.
So, very often when we offer people a genetic test,
we get an inconclusive or a negative result
and one of the important messages there is that,
well, that doesn't mean that we can conclude one way
or the other whether or not their pancreatic cancer
that they have or that some of their relatives has
can be definitively explained.
But we do think it is very helpful
for selected families to undergo genetic testing
and this can not only provide help for the families,
but even the affected individual with pancreatic cancer
because sometimes that has important treatment implications
and that can be discussed with their doctor.
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So the current best test for screening for pancreatic cancer
is a test involving imaging the pancreas,
and so looking for tumors directly by imaging.
And there have been some excellent studies comparing
the different types of tests that are involved.
We can do endoscopic ultrasound
which is like having an endoscope
with an ultrasound all-in-one,
a patient undergoes sedation
and we have a very careful review of the pancreas
and we believe in general
that that's the most accurate test.
There are other tests that can be very useful,
for example, an MRI scan allows us
to visualize the pancreas very well, as well,
particularly pancreatic cysts,
and so in the screening setting
those are the two main tests we offer
our patients who are undergoing screening.
If we suspect that there may be more
going on in their pancreas,
if there's something abnormal we wanna look at further,
we'll ask the patient to undergo a CT scan.
We like to avoid CT scanning on a regular basis
because of the radiation dose,
which although is very low, we'd prefer to avoid.
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Currently, there isn't an effective blood test
to diagnose pancreatic cancer,
particularly diagnose pancreatic cancer
at an early stage when it's curable
which is what we really want from a screening test.
There's a lot of research that's interesting
and we're hopeful that we'll be able
to develop a pancreatic cancer test
that's just a blood test that could be used for screening.
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When we look at our pancreatic screening studies,
most patients who undergo pancreatic screening
thankfully will have a completely normal pancreas.
A significant fraction of patients
will have small pancreatic cysts.
Thankfully most of those will never develop
into pancreatic cancer and can be followed.
A very small number of patients
will have a small pancreatic mass
that in fact is a pancreatic cancer,
and in many cases, that's a curable,
treatable pancreatic cancer.
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It is worth trying to detect pancreatic cancer early.
There are patients who are cured
of their pancreatic cancer if it's detected early.
We have had patients with pancreatic cancer detected
through screening who've lived for many years
and we believe are cured from their pancreatic cancer,
and the key point is detecting it early.
And that means detecting small pancreatic cancers
while they're still confined to the pancreas.
It's also true that gradually
pancreatic cancer treatment is improving,
and so we believe that patients should undergo a screening
if they meet pancreatic screening criteria.
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Besides undergoing pancreatic screening,
people who are concerned about their risk
of developing pancreatic cancer,
we advise them to have a healthy lifestyle,
to not smoke, to avoid excess alcohol,
to exercise well and have a good diet
and we make these recommendations based on evidence
that patients who develop pancreatic cancer
are more likely to be obese, to smoke,
although we don't have evidence
that these lifestyle remedies will actually prevent
you from developing pancreatic cancer,
we also know that these
are very good general health recommendations
and that's why we recommend them for patients.
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