Most of us don't give much thought to our pancreas, the organ located in back of the stomach that helps us digest foods. And yet while pancreatic cancer is relatively rare — it accounts for 3 percent of all new cancer cases in the U.S., according to the American Cancer Society — it is one of the deadliest: The five-year survival rate is only a shocking 7 percent. That's because this type of cancer is usually spotted later, when the disease has spread to other parts of the body. Before then, it's relatively symptom-free, though some patients with chronic pancreatitis eventually develop pancreatic cancer.
Researchers are discovering that pancreatic cancer can run in families, like gray eyes or ears that stick out like Dumbo. If two close family members (two of your siblings, say, or your grandparent and parent) got pancreatic cancer, here is what you need to know to determine your risk, and how to protect yourself from the disease.
1. Chronic pancreatitis can be a risk factor for pancreatic cancer.
What is pancreatitis? Pancreatitis simply means inflammation of the pancreas, the gland that produces enzymes that help digestion and hormones that help regulate the way your body processes sugar. Though most people with pancreatitis never develop pancreatic cancer, chronic pancreatitis — defined as a long-term inflammation of the pancreas — has been linked with an increased risk of pancreatic cancer, particularly in smokers. The risk of developing pancreatic cancer appears to be highest in rare types of early-onset pancreatitis — such as hereditary pancreatitis and tropical pancreatitis. But even though the link between chronic pancreatitis and pancreatic cancer has been established, one 2010 study found that over a 20-year period, only around five percent of patients with chronic pancreatitis will develop pancreatic cancer.
What about patients who experience acute pancreatitis, defined as pancreatitis that appears suddenly and lasts for days? Acute pancreatitis symptoms can include abdominal pain that radiates toward the back and is worse after eating, increased pulse, fever, nausea, vomiting, and stomach tenderness related to pancreatitis pain. Experts say that those who have only a single attack of acute pancreatitis — without developing recurrent pancreatitis or chronic pancreatitis — do not progress to pancreatic cancer. That said, more research is still needed to determine a definite relationship between acute and chronic pancreatitis.
2. Genetic changes can increase your chances of developing pancreatic cancer, but not all mutations carry the same risk.
"These genetic changes can range from common ones that only slightly increase your risk of pancreatic cancer — from 1 to 2 percent — to rare mutations that carry a very high lifetime risk, which is defined as higher than 5 to 10 percent," says Alison Klein, PhD, director of the National Familial Pancreas Tumor Registry at Johns Hopkins University, as well as an associate professor of oncology at Johns Hopkins University Medical School.
3. Inherited genetic changes probably play a role in most pancreatic cancers.
According to Dr. Klein, ten percent of people with pancreatic cancer carry the rarer mutations, like BRCA2, ATM, and PALB2. But Klein believes the remaining cases of pancreatic cancer may be linked to the lower-risk genes, environmental causes, and even chance.
4. Researchers have identified 20 percent of the inherited genes that cause cancer.
There are still 80 percent to go. Why is it so difficult? "The average person has over 4 million genetic variants," says Klein. Another challenge: It's better to test the family member who already has cancer first. "That way we can establish if that person has a mutation in a gene that's already been recognized or a new one," she explains. Unfortunately, because pancreatic cancer has such a low survival rate, getting the patient tested in time can be difficult.
5. Several of these inherited genetic mutations cause multiple types of cancer.
You've probably heard of the BRCA2 gene because of the role it plays in breast cancer. BRCA2 also ups your risk of ovarian and pancreatic cancer, and prostate cancer in men. Here's why: Several of the “cancer “ genes, such as BRCA2 and ATM have important roles in correcting “errors” that occur in our DNA from aging and certain environmental causes (say, pollutants). These genes make proteins that “repair” these errors. Cancer cells often have lost this repair capacity. Since humans have two copies of every gene in every cell, an individual with an inherited mutation in one of these genes just needs to lose the normal copy of the gene in one of their cells for this cell to no longer be able to repair DNA. Once that happens, the cancerous cells begin to grow rapidly and form tumors.
6. Type 2 diabetes can up your chances of pancreatic cancer.
Not all people with type 2 diabetes will develop pancreatic cancer. But If you've had this kind of diabetes for more than five years, your risk factor goes up 1.5 times. If you've recently been diagnosed with diabetes, talk to your doctor about exams to rule out pancreatic cancer. "Studies show that up to 25 percent of pancreatic cancer patients have been diagnosed recently with diabetes, or their symptoms have gotten worse," says Klein.
7. Protect yourself by getting tested.
If you have several relatives who had pancreatic cancer OR other types of cancer, especially breast, ovarian, colon, and melanoma, you should go to a genetic counselor to see if testing is right for you. Insurance will cover it if you have a strong case--multiple family members with the disease if you come from a high-risk ethnic group. Testing can at least determine your odds, which may be enough to trigger lifestyle changes.
8. Stop smoking now.
And tell the smokers in your life to do the same, as second-hand smoke carries nearly the same risk. "Cigarette smoking doubles the risk of pancreatic cancer and about 25 percent of pancreatic cancers are due to cigarette smoking," says Klein. It could be that the smoke triggers the low-risk genes.
9. Cut back on bacon.
Eating lots of cured, smoked meats — think sausages, ham, bacon, jerky, pastrami — also ups your risk for pancreatic cancer.
10. Try to lose weight.
Having a BMI higher than 35 increases your risk.
11. Go easy on the alcohol.
Heavy drinkers — defined as more than six drinks a day — have a greater than usual chance of developing pancreatic cancer, maybe because too much alcohol can lead to liver damage, which in turn can trigger pancreatic cancer.
12. Talk to your doctor about taking aspirin.
A study from the Yale School of Public Health found that an aspirin (either low-dose or regular) a day could cut your risk of developing this type of cancer in half. And the longer you take it, the better. The link: Aspirin reduces inflammation, which may play a part in all sorts of diseases, including cancer.
13. Consider joining a clinical trial.
"There are ongoing clinical trials for individuals with a family history of pancreatic cancer to determine if we can detect pancreatic cancer at an early curable stage in these patients," says Klein. For more information, go here.