A deadly trend: pancreatic cancer cases increase, Life & Culture

[NEW YORK] As an avid reader of obituaries, I was struck by the number of people who today succumb to pancreatic cancer, a cancer long considered rare.

And relatively speaking, it is still rare, accounting for only 3 percent of all cancers. But it's also one of the most lethal because the symptoms almost never develop until the disease is advanced and incurable.

Although 55,440 cases, affecting 29,200 men and 26,240 women, are expected to be diagnosed this year in the United States, 44,330 die, often in the months following diagnosis, making it the fourth leading cause of death. cancer in this country (after lung cancer, colorectal cancer and breast cancer). In addition, it is poised to become the second most deadly cancer by 2030.

At the same time, pancreatic cancer cases are increasing, even though the main known risk factor – cigarette – has been declining for years. decades. This alone has prompted researchers to seek explanations for other causes and, hopefully, to find ways, in addition to quitting, to prevent it and to prevent it. detect it while healing it.

In most of the 6% surviving, pancreatic cancer is discovered early by accident, usually during a scintigraphy or surgery for another reason. For example, in 2009, Judge Ruth Bader Ginsburg of the Supreme Court had a portion of her pancreas removed after a routine scanner revealed an injury of one centimeter. While this lesion was benign, a smaller tumor that the surgeon found was malignant and had not yet spread beyond the pancreas.

The pancreas is a small, two-part glandular organ about 7 inches long and 1.5 inches wide. behind the stomach. It fulfills two vital functions. Part of the gland is a source of digestive enzymes and the other part produces insulin and glucagon hormones that control blood levels of glucose and fatty acids.

Some known risk factors for pancreatic cancer are beyond the control of an individual: to be an Afro-American or Ashkenazi Jew and to have two or more first degree relatives (parents or siblings) who have had the Cancer.

But it is the modifiable risk factors that are the most worrying. In addition to smoking, which accounts for between 20% and 25% of pancreatic cancers while this risk factor continues to decline, the main risks of pancreatic cancer and mortality are obesity, type 2 diabetes and the metabolic syndrome. The data collected in many studies "clearly show a relationship with obesity," said Donghui Li, a molecular epidemiologist at the MD Anderson Cancer Center in Houston. "The higher the BMI, the higher the risk of pancreatic cancer," she said, referring to the body mass index. "Obesity contributes to the onset and progression of this cancer."

Li added, "The fat distribution also plays a role – the higher the size / hips ratio, the greater the risk." She found that the risk of cancer was all the higher as the person became obese earlier in life and the survival time was shorter in obese people after the diagnosis of cancer

. Obesity is also the leading risk factor for type 2 diabetes, in which the body resists the action of insulin, prompting the pancreas to produce more and more of this hormone. Insulin promotes cell growth, providing a link between diabetes and pancreatic cancer development.

However, the relationship is complicated. In a 2011 report published in Molecular Carcinogenesis, Li noted that "impaired diabetes or impaired glucose tolerance is present in 50 to 80 percent of pancreatic cancer patients." She said, "Diabetes is at the both a cause and a consequence of cancer ", although diabetes or organ cancer that controls blood sugar is not very clear.

European study of over 800,000 people with type 2 diabetes revealed that this disease is sometimes an early sign of an otherwise hidden pancreatic cancer.

In studies at the Mayo Clinic, elevated glucose levels, a condition called prediabetes, have been detected in some patients two years before the diagnosis of pancreatic cancer.In these patients, explained Li, diabetes is actually a symptom of hidden cancer.This is a type of diabetes called 3C, caused by a sick or damaged pancreas, and the researchers med Researchers are looking for ways for doctors to easily distinguish type 3C and type 2 diabetes.

The lag time between the development of diabetes and the diagnosis of cancer is a window of potential opportunity that may allow detecting cancer at an early and curable stage, says Li.

If a cancer biomarker has been identified, it may be possible to find cancer in these patients when the tumor is too small to be seen on a scanner and before as the symptoms develop. For example, an antibody could target a molecule on small tumors.

Li urged doctors to be aware of the possibility of hidden cancer in newly diagnosed diabetic patients aged 50 or older, with no family history of the disease, lose weight and their diabetes is not controlled by oral medication.

In general, when diabetes or prediabetes is present for many years before pancreatic cancer is discovered, the abnormality of blood glucose probably played a role. or promote cancer growth. The more diabetic patients, the lower the risk of cancer, but even after 15 years, the risk of pancreatic cancer is higher than in people without diabetes.

In less than 10% of people with familial pancreatic cancer, Many of them are in a national tumor registry at the Johns Hopkins Medical Center, genetic tests have identified several genes associated with cancer that could predict their cancer risk. The higher the risk, the more frequent CT may be for finding a relatively early cancer.

Early diagnosis is essential, Li said, because pancreatic cancer is highly resistant to most therapies and often reappears after surgery. Currently, only 20 percent of cancers are even eligible for surgery, she said. The pancreas is next to very large blood vessels and when the tumor involves them, it can not be removed without danger.

A positive point for people with diabetes: Metformin, often used by patients to control blood sugar, has Studies have been associated with a reduced risk of pancreatic cancer and a better chance of survival for those who develop cancer. This drug, which has also been linked to longevity and healthy aging, is an inexpensive generic with an excellent safety record.

NYTimes