Pancreatic cancer diagnosed earlier, patients living longer

Last Updated: 2020-02-06

By Megan Brooks

NEW YORK (Reuters Health) - A new trends analysis shows a significant increase in the number of patients diagnosed with stage-IA pancreatic ductal adenocarcinoma (PDAC) in recent years and a decrease in the average age at diagnosis. These patients are also living longer.

"Survival for patients with Stage IA pancreatic cancer is much better than people realize and it has gotten better in recent years," Dr. Michael Goggins of The Sol Goldman Pancreatic Cancer Research Center at Johns Hopkins Medical Institutions in Baltimore, Maryland, told Reuters Health by email.

Dr. Goggins and colleagues analyzed trends in newly-diagnosed stage-1A PDAC between 2004 and 2016 using the National Cancer Institute's SEER database.

The age-adjusted incidence of stage-IA PDAC increased significantly from 2004 to 2016 by 14.5% annually (P<0.001), the researchers report in the Journal of the National Cancer Institute.

"We suspect the increased diagnoses of Stage IA pancreatic cancers is the result of several factors, including earlier diagnosis and surgical management, improved insurance coverage, and enrollment of more eligible individuals, (both those with incidentally-detected pancreatic cysts and those with familial/genetic risk), into pancreatic surveillance programs," the authors write.

Having insurance, either private or Medicare, was associated with significantly greater odds of being diagnosed with stage-IA PDAC compared with those on Medicaid or without insurance, independent of race, ethnicity, marital status and other factors, "supporting the hypothesis that underinsurance and/or poverty, lower health care access and utilization reduces the likelihood of having the earliest-stage, most-curable PDAC," they add.

The average age at diagnosis for stage-IA and -IB cases fell by 3.5 years and 5.5 years, while the average age increased for higher-stage cases (by 0.6 to 1.4 years). The five-year overall survival for stage IA PDAC improved from 44.7% in 2004 to 83.7% in 2012; 10-year survival improved from 36.7% in 2004 to 49.0% in 2007.

"Identifying patients with stage-IA pancreatic cancer is challenging. Currently only approximately 3% of patients are diagnosed with this stage of the disease because usually the patient does not have any symptoms until the cancer has progressed to a higher stage," Dr. Goggins told Reuters Health.

"Patients who are known to be at significant risk because they have a family history of pancreatic cancer in multiple close relatives, or carry a gene mutation that is associated with increased pancreatic cancer risk can undertake regular pancreatic surveillance, but most patients who develop pancreatic cancer are not in one of these risk groups," he said.

SOURCE: http://bit.ly/2uapQut Journal of the National Cancer Institute, online January 20, 2020.