March 20, 2020
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Improvements in screening may be linked to increase in early-stage pancreatic cancer diagnoses

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Michael Goggins, MD
Michael Goggins

Increases in the proportion of patients diagnosed with pancreatic cancer at an earlier stage and younger age may be due to improvements in early detection and diagnosis, according to study results published in Journal of National Cancer Institute.

“This research was prompted by our own experience undertaking pancreatic screening,” Michael Goggins, MD, professor of pathology, medicine and oncology at Johns Hopkins University School of Medicine and director of the early detection research laboratory at Sol Goldman Pancreatic Cancer Research Center at Johns Hopkins, told Healio. “We found that patients with stage I pancreatic cancer have excellent survival, and so we wanted to examine national trends in stage IA pancreatic cancer diagnoses and outcomes.”

Goggins and colleagues hypothesized that improvements in survival among those with pancreatic ductal adenocarcinoma could be attributed in part to the development of pancreatic cancer surveillance programs for those with familial or genetic risk, as well as improvements in the detection and management of pancreatic cystic neoplasms.

The researchers used the SEER database to pool data from 2004 to 2016 to examine trends in stage of newly diagnosed pancreatic cancer, age at diagnosis and survival.

Increases in the proportion of patients diagnosed with pancreatic cancer at an earlier stage and younger age may be due to improvements in early detection and diagnosis.

They used t-tests, Wilcoxon rank-sum and Fisher’s exact tests to compare demographic and clinical characteristics of patients with (n = 1,719) or without (n = 91,478) stage IA pancreatic cancer. Changes in age and tumor size at diagnosis over time were assessed through linear regression, interaction analysis was used to examine differences in trajectories across stage groups, and Cox proportional hazards models were used to test for linear trends in survival.

Results showed incidence of stage IA pancreatic cancer increased significantly between 2004 and 2016 (annual percent change [APC], 14.5%; 95% CI, 11.4-17.7) compared with stage IIA disease (APC, 2.9%; 95% CI, 2-3.9), stage III disease (APC, 1.4%; 95% CI, 0.79-2.1) and stage IV disease (APC, 0.57%; 95% CI, 0.35-0.79).

The mean age of patients diagnosed with stage IA pancreatic cancer was about 6 years younger than that of patients with higher-stage cases (61.4 years vs. 67.5 years).

During the study period, average age at diagnosis declined by 3.5 years (95% CI, 1.2-5.9) for patients with stage IA disease and by 5.5 years (95% CI, 3.4-7.6) for patients with stage IB disease. However, average age at diagnosis increased by 0.6 to 1.4 years for patients with higher-stage disease.

Patients with stage IA disease were more likely than those with higher-stage disease to be female (52.6% vs. 48.6%), be married (67.3% vs. 57.2%), live in urban areas (91.7% vs. 88.7%) and be insured (OR = 2.45; 95% CI, 1.96-3.06). They were less likely to be black (10.2% vs. 12.5%) and more likely to be of other nonwhite races (11.9% vs. 8.4%).

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Five-year OS for stage IA pancreatic cancer improved from 44.7% (95% CI, 31.4-63.7) in 2004 to 83.7% (95% CI, 78.6-89.2) in 2012. Researchers also observed improvements in 10-year OS for stage IA disease, from 36.7% (95% CI, 24.1-55.8) among those diagnosed during 2004 to 49% (95% CI, 37.2-64.6) among those diagnosed in 2007.

“Pancreatic cancer is so deadly primarily because it is almost always diagnosed after symptoms develop, and by then the disease is usually at an advanced stage,” Goggins told Healio. “These results highlight the potential for pancreatic surveillance to cure patients if their pancreatic cancer can be detected early. We continue to evaluate the long-term outcomes of patients in our Cancer of the Pancreas Screening (CAPS) program and to investigate better ways to detect pancreatic cancer early.” – by Jennifer Southall

For more information:

Michael Goggins, MD, can be reached at Johns Hopkins Medical Institutions, Cancer Research Building 2, Room 342, 1550 Orleans St., Baltimore, MD 21231; email: mgoggins@jhmi.edu.

Disclosures: The study was funded by grants from NIH and a Stand Up To Cancer-Lustgarten Foundation Pancreatic Cancer Interception Translational Cancer Research Grant. The authors report no relevant financial disclosures.