Screening High-Risk Populations

Pancreatic tumor marker serum CA 19-9 at heart of early cancer screening

(RxWiki News) Detecting pancreatic cancer before its symptoms occur could save lives. Scientists are working on a method that can do just that.

In a new study, researchers describe how they have been able to effectively detect pancreatic cancer at its earliest and most curable stage in people who have high risks for the disease. The method involves looking for a tumor marker called serum CA 19-9, then performing an endoscopic exam if the levels of this protein are elevated.

"Discuss your risk factors for pancreatic cancer with your doctor."

According to the American Cancer Society, an estimated 44,000 Americans will be diagnosed with the disease and 37,660 will die from it in 2011. It's the fourth leading cause of cancer death in the United States.

"We typically wait for symptoms such as jaundice, weight loss and abdominal pain to occur prior to diagnostic testing," said lead author, Richard Zubarik, M.D. with Fletcher Allen Health Care at the University of Vermont. "Unfortunately, symptoms do not usually occur until the disease has progressed to a more advanced stage."

When this cancer is detected at its earliest stages, overall survival is greatly improved.

A family history of pancreatic cancer is the most common risk factor for the disease. Having a first degree relative increases a person's risk roughly two to five-fold. Age is also a significant factor. It's usually diagnosed in people over the age of 50. Dr. Zubarik took these factors into account when designing the study.

"A more active screening approach to pancreatic cancer, which can detect the disease at an earlier, more curable stage, is desperately needed. This was the impetus for carrying out our pancreatic cancer screening study," Dr. Zubarik said.

The study involved 540 patients aged 50 to 80 who had at least one first-degree relative (parent, sibling or child) with pancreatic cancer. Each person was screened for the tumor marker CA 19-9, which indicates presence of the disease. If levels were high, a targeted endoscopic ultrasound (EUS) was performed. EUS involves inserting a slim tube into the body to examine an organ.

Another 124 patients who had been diagnosed with pancreatic cancer between September 2006 and July 2009 at the University of Vermont served as the comparison group. In this group, only one patient (0.9 percent) presented with stage 1 pancreatic cancer. Median survival in this group was seven months, and 10 percent live for two years.

In the study group of 540 patients:

  • CA 19-9 was elevated in 27 patients
  • Suspicious findings were detected in five patients
  • Stage 1 pancreatic cancer was diagnosed in one patient

Dr. Zubarik notes that the patient who was diagnosed with pancreatic cancer has not had a recurrence (return of the disease) in three years after surgery.

“Our results showed that potentially curative pancreatic adenocarcinoma can be identified with this screening protocol," Dr. Zubarik said. "Stage 1 pancreatic cancer is more likely to be detected by using this screening protocol than by using standard means of detection,” he concludes.

The study appears GIE: Gastrointestinal Endoscopy, the peer- reviewed journal of the American Society for Gastrointestinal Endoscopy.

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Review Date: 
July 29, 2011