Gastroenterologist at Hackensack University Medical Center, Dr. Rosario Ligresti talks about the importance of catching pancreatic cancer early.
Interview conducted by Ivanhoe Broadcast News in 2022.
We’re talking about pancreatic cancer. That’s one of the cancers that our viewers know they’re afraid of because it’s caught late often. There hasn’t been a whole lot of success in treatment. Can you talk to me about screening for pancreatic cancer. Has there been a reliable way of finding pancreatic cancer early?
LIGRESTI: We know in pancreatic cancer that the earlier you can find the tumors, the more likely you are to cure the patients. The reason why pancreas cancer is one of the bad cancers and why there’s such a negative stigma attached to it is that the vast majority of patients, by the time they come to see me are already advanced. They already locally advanced or stage 3 disease or worse. The problem with the pancreas is that it’s a quiet organ. It sits in the back and doesn’t make much trouble during the patient’s lives. Unless they have symptoms from it, they don’t know they have a pancreas. Sure enough, when they get symptoms from something like pancreas cancer, generally the tumor has spread far beyond the pancreas. For the longest time, there’s been a concerted effort to try to find these tumors at the earliest possible stages. The problem is having done this now for 25 years, there has not been a good way to do this that’s cost-effective, reproducible, and readily available to the general population where we have to screen pancreas cancer. We know it’s not a common cancer. We know that there are in fact only about 60,000 patients who get it every year. The problem with that is that most of those patients will die within a year from the diagnosis because most of those patients are being found too late. The body knows that the pancreas has a tumor developing at a very early point in tumor development, probably one to two years before clinically available symptoms. Due to that, we knew that there was always this idea that you could theoretically screen for pancreats cancer. The problem was finding the exact way to do that. We know that by imaging, for example, MRI and the scopic ultrasound, you could find pancreas cancers early. Then to ask large numbers of patients to undergo these cumbersome screening tests, which can be expensive, time-consuming, invasive, became too cost ineffective. There’s been a concerted effort to try to find some better way. We know that because the body identifies these cancers very early, in the serum, in blood there’s probably going to be markers that are going to be detectable for finding these tumors at a very early stage. In fact, there are plenty of markers that have been looked at over the years that have been shown to be elevated in pancreas cancer. The real trick to finding cancers early on is finding the right combination of these markers in the blood so that you can make an accurate diagnosis. In fact, this year a company that it’s been doing this for a number of years, was able to find that right number of biomarkers, in this case, eight biomarkers plus a normal biomarker that’s used in pancreas cancer detection called CA 19-9. When they combine those eight biomarkers plus CA 19-9, they arrived at a test that can detect pancreas cancer at stage 1. Very early-stage pancreas cancer 93% of the time.
How accurate is it?
LIGRESTI: Ninety three percent. They’re finding early stage, stage one pancreas cancers 93 percent of the time, which in my opinion, having done this a very long time, is in fact a game changer. You now have a blood test that’s clinically available, that’s easy to do, that’s detecting these cancers at very early stages very accurately.
Can you describe again how it works? Is it as simple as imaging blood test?
LIGRESTI: Patients should have this done in a center that does a lot of this. We know that it’s not just simply having the general doctor ordering a blood test and then trying to interpret the results. Basically, we are looking at this in patients that are for the time being considered increased risk for pancreas cancer development. We’re not looking at everyone, but in that group of patients that is considered increased risk, and we can go into shortly what the increased risk is all about. We’re offering those patients a screening blood tests. If the blood test is elevated or abnormal, then we are then going on to more accurate investigation and that generally involves MRI of the abdomen or endoscopic ultrasonography, a very specialized type of endoscopy.
Let’s talk a little bit about these patients who might be at increased risk, who would be eligible or who would be appropriate for this test?
LIGRESTI: We know in pancreas cancer, there are certain populations that get the disease more frequently. We know that currently there are patients that have genetic abnormalities. For example BRCA, the gene that causes breast cancer is associated with breast cancer, in fact, is associated with a substantially increased risk of pancreas cancer. We also know that other patients that have cancer syndromes, for example Lynch syndrome, another very frequent syndrome that causes cancers of other organs, like colon and ovarian and breast, but also pancreas. We know those groups of patients should be screened. Then other than genetic abnormalities, we know that patients that have strong family histories more than one first-degree relative with pancreas cancer have an increased risk of pancreas cancer. We are screening that group as well. This year, we also identified diabetes as being an increased risk. Patients that have longstanding diabetes for more than 20 years, or alternatively new onset diabetes, they develop diabetes after the age of 50. Pancreas cancer should certainly be considered at an increased risk. Those groups are the groups were on the screen.
Can you tell me a little bit about the patient, Nancy Perez? She had a family history of the BRCA.
LIGRESTI: Nancy Perez, has been a long-term patient of mine. She has a very strong family history of pancreas cancer. She came to see me a few years ago because her mom had pancreas cancer, her maternal aunt had pancreas cancer and her sister had pancreas cancer. She was very concerned what her risk might be. She’s been seeing me for this and she was one of our first patients in the formal screening protocol.
Did you in fact find any reason for her to be concerned? Did you find pancreas cancer?
LIGRESTI: No, thank goodness. Again, in most large screening populations, it’s not going to be a very large number that are found to have actionable lesions or pancreas cancer. Needless to say, you’re finding about three to five percent in those groups that you’re screening, that in fact have actionable lesions at very early stages. Nancy, thank goodness, was a normal study this year.
How often will she come back.
LIGRESTI: She’ll be coming back every year. The normal protocol for us is starting at the age of 50 and then doing it every year indefinitely.
What is the cost for this? Does insurance pick this up?
LIGRESTI: The problem with these kinds of new tests is the FDA still hasn’t caught up. Due to that, it’s not FDA approved, but it is CLIA-certified. It can be sold commercially in 49 out of 50 states. The FDA eventually will get enough data based on studies that that we’re seeing, that we’re conducting here. Most likely within a year, the FDA will approve it and then it will be covered by insurance. Currently if in fact we determine that patients would be best served by having the blood tests or screening, the test is about one thousand dollars.
It it still to save a life?
LIGRESTI: Clearly. We know it’s cost-effective.
Can you speak a little bit about the colonoscopy case?
LIGRESTI: Yes. She’s been a patient of mine also for quite some time, not for colon cancer screening, but for other upper GI diseases. She’s turned 49 this year. She finally got one down and heard a lot about it and said, “Hey, why don’t we do a colonoscopy?” This will be our first colonoscopy. She had her first colonoscopy about a month ago and did very, very well.
Did they find any?
LIGRESTI: We found, thank goodness, no polyps, but she was also one of the first people that we use GI Genius on. I told her, “I said not only are you getting your first colonoscopy, but you’re getting a much better first colonoscopy.”
So good relief, right?
LIGRESTI: Definitely relieved. Not only that, she doesn’t get to do it again for 10 years.
END OF INTERVIEW
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