The news that beloved game show host Alex Trebek has advanced stage pancreatic cancer hit his millions of fans hard this week. His illness has elicited heartbreak and support. As a clinician who treats pancreatic cancer, I anticipated the reaction that would follow next.
Fear.
While it is a rare form of cancer, pancreatic cancer is possibly the most lethal. Survival rates are slim – fewer than 10 percent with advanced disease will survive five years after diagnosis. It is also fairly asymptomatic until it reaches an advanced stage, contributing to the high mortality rate.
These two facts whip through people’s minds until the inevitable question arises: “What if I have pancreatic cancer but don’t know it?”
For too many years, the medical community has been unable to answer that question. Pancreatic cancer is rare enough that widespread screening programs are simply too expensive and generally unproductive. And it is insidious enough that it eludes such inexpensive diagnostic methods as blood tests.
So, when a celebrity like Trebek or Patrick Swayze, who died in 2009, reveal their pancreatic cancer diagnosis, the public is left to mourn and worry.
I firmly believe that will change.
Trebek’s announcement came with a brave promise that “I’m going to fight this … and with the love and support of my family and friends and with the help of your prayers also, I plan to beat the low survival rates statistics for this disease.”
Trebek’s outlook represents precisely the type of fighting mindset we must all share in the face of this disease. Every day, we develop a better understanding of the underlying biology of pancreatic cancer and create new, smarter treatments to target the disease.
At my institution, for example, the Anita Erickson Pancreatic Cancer Early Detection Program is working with a grant from the National Cancer Institute to offer clinical research studies and early detection programs to help turn the tables on pancreatic cancer.
While few centers in the U.S. are able to offer early detection programs – our effort is possible through the philanthropic support of the Anita Erickson estate – the work being done will go a long way toward detecting pancreatic cancer early, when it is most treatable and curable.
People who have a strong family history of pancreatic cancer or certain hereditary acquired gene mutations can enroll in the program, which offers genetic counseling and regular advanced endoscopies, MRIs and other diagnostic tests. The hope is to develop an effective screening protocol. As part of the program, participants also enter a registry, a de-identified database to help identify and treat this complex disease.
Most of the patients we see in our high-risk clinic have strong family histories that may predispose them to an increased risk of pancreatic cancer or other cancers. Some will have a mutation in a pre-disposition gene although most will not have a measurable genetic defect.
Like Trebek, we are undeterred. Every year we discover additional inherited genes that put people at high risk. We are learning, we are striving, and we are fighting. Importantly, we are collaborating. By pooling knowledge nationwide and participating in clinical trials, we hope to get the upper hand on pancreatic cancer.
Our team includes a geneticist, genetic counselors, radiologists, pathologists, gastroenterologists, pancreatic surgeons, and medical oncologists. This multidisciplinary team supports all aspects of care including communicating with each other and with patients’ primary care physicians. This is critical for people who are concerned that they might be at high risk, because too many of them tell us they have nowhere to go for this type of comprehensive evaluation.
Unlike breast cancer or prostate cancer, pancreatic cancer has no standard established infrastructure for monitoring, screening and early detection. Without an organized way to seek help, the fear factor for people with family histories is pretty high.
The work by my colleagues and nationwide provide a ray of hope in a landscape that is too often painted in broad, bleak strokes. It gives people a way to seek monitoring and care – and to participate in clinical research trials that will result in more efficient diagnosis and treatment.
In his role on Jeopardy!, Alex Trebek has spent his entire career in search of the right questions. What I and my colleagues hope to provide him and future generations are some answers.
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