Oct. 30, 2024
In recent years, the landscape of pancreatic cancer screening has undergone significant transformations, with research and technology paving the way for innovative approaches to early detection and management.
Michael B. Wallace, M.D., an interventional endoscopist at Mayo Clinic Comprehensive Cancer Center in Jacksonville, Florida, emphasizes the critical role of genetic testing, artificial intelligence (AI) and collaborative research in continuing to shape the future of pancreatic cancer care.
Genetic testing and innovative screening for pancreatic cancer
The current guidelines recommend pancreatic cancer screening for individuals at high risk, including those with a familial history of the disease or known genetic mutations. Genetic testing, however, is largely underutilized.
"Less than one third of people who are eligible actually get genetic testing," says Dr. Wallace. "It can be a lifesaving procedure that is available and covered by health insurance."
Efforts are underway to increase awareness and uptake of genetic testing, which is crucial for identifying individuals at increased risk and implementing early intervention strategies. Patients identified as high risk genetically, however, make up only about 10% of pancreatic cancer diagnoses. The other 90% are often diagnosed in what Dr. Wallace describes as an opportunistic way — meaning their pancreatic cancer risk is usually an incidental finding such as a cyst or neoplasm.
Dr. Wallace and his colleagues around the world are working intensively to establish impactful screening mechanisms for these patients. One such test analyzes cyst fluid to determine the risk of malignancy. Another test that evaluates pancreas juices for cancer risk is currently being evaluated for clinical use. Other screening research aims to continue to predict pancreatic cancer risk.
"We now potentially have the ability to push back the window of opportunity by three years to detect the cancers when they're very early, where our chance of cure is much higher," says Dr. Wallace.
AI for screening and classifying risk
When a patient is identified as being at high risk of pancreatic cancer, it's important that the patient adhere to a screening plan that is right for the situation. Dr. Wallace notes that about 40% of people have some type of pancreatic cyst, but only a very small percentage of those cysts will become malignant, so evaluating those to understand cancer risk is incredibly important.
Dr. Wallace and his colleagues are nearing the end of a five-year study evaluating an AI algorithm designed to do just that. The algorithm helps care teams classify high- and low-risk cysts. It can read a scan in half a second, compared with the 20 to 30 minutes a radiologist may need. Preliminary data published in 2019 was promising.
This research, expected to conclude next year, has the potential to reduce the need for invasive biopsies and to enhance the accuracy of screening programs and improve patient outcomes. Similar research is being done for solid pancreatic cancers as well.
Collaborative research and future directions
Collaborative research is ultimately what is driving progress in pancreatic cancer screening — and therefore in pancreatic cancer outcomes. From advancements in screening to risk identification, experts around the world are making advancements for pancreatic cancer.
In addition to the screening and early identification methods being evaluated at Mayo Clinic, industry research is focused on using standard indicators such as body weight, blood sugar and cholesterol to predict pancreatic cancer risk.
"We anticipate in the near future that we'll be able to identify not only patients who are known to be at high risk for pancreatic cancer because of family history or known genetics but also the more common situations," says Dr. Wallace. "We're all getting our weight and our sugars and our cholesterols checked every year. Might there be a signal there that we could use to say you might consider getting screened for pancreatic cancer?"
The integration of genetic testing, AI and innovative screening technologies into clinical practice offers the potential to identify pancreatic cancer at earlier, more treatable stages.
"We can't expect every physician to have a high index of suspicion for every disease," says Dr. Wallace. "We're hoping to implement these advancements as ambient clinical intelligence to monitor patients and alert care providers of pancreatic cancer risk."
For more information
Refer a patient to Mayo Clinic.