Dr. Carletta Collins

Several years ago in the outpatient surgical center at West Park Hospital, I was approached by a nurse. She explained to me that her husband’s family had a long history of pancreatic cancer and she was curious if there was a recommendation for screening for pancreatic cancer. At that time, the answer was no; we had no screening recommendations. I told her that we hopefully would one day and that I would let her know when those were available.

It was frustrating. I want to help people, but I had no way to help this family. Now, years later, we finally do have recommendations. I no longer work at Cody Regional Health/West Park Hospital and have no way to contact this particular nurse to tell her that we now FINALLY may have a way to help her husband.

In the passing of these years, we also have learned a lot about possible genetic mutations associated with pancreatic cancer. At the time that I was approached by the nurse, the association of pancreatic cancer and BRCA mutations and other mutations was little understood. We now know that pancreatic cancer risks are increased with CDK2A mutations, BRCA1, bRCA2, PALB2, ATM, MLH1, MSH2 and MSH6 mutations.

In recent months, the International Cancer of the Pancreas Screening (CAPS) consortium has come to a consensus for recommendations on screening for patients with increased risk for familial pancreatic cancer.  These recommendations are as below.

WHO:

• Individuals with at least one first degree relative with pancreatic cancer who also had a first degree relative with pancreatic cancer. For example, if your father had pancreatic cancer and his brother also had it.

• For patients with BRCA2, BRCA1, PALB2, ATM, MLH1, MSH2, MSH6 gene mutations with at least one first degree relative (sibling, parent) with pancreatic cancer.

• All patients with Peutz–Jeghers syndrome.

WHAT:

Screening would include MRI, MRCP plus Endoscopic US, plus fasting blood glucose and/or Hgb A1c initially with alternating follow-up exams annually.

WHEN:

• Screening is to start at age 50 or 10 years younger than youngest affected family member for those with family history and no known mutation

• For patients with CDKN2A and Peutz-Jeghers syndrome, start at age 40

• For BRCA1, BRCA2, ATM, PALB2, MLH1 / MSH2, start at age 45 or 10 years younger than the youngest affected family member

I am excited to share the new screening recommendation for pancreatic cancer, because I think it will save lives. I also think it is important to get the word out to as many people as possible. Early diagnosis is key to survival with this disease.

As mentioned before, when approached with these questions previously, I had no way to help. I wanted to help, but couldn’t! Now, I can help.

If you have any of the above risk factors, please discuss them with your primary care provider or feel free to see me at Powell Valley Clinic to see if you qualify for screening or evaluation for possible genetic mutations. If you are at risk, this is an important thing to do.

(Dr. Carletta Collins practices medical oncology/hematology at the Powell Valley Healthcare Clinic. Her office can be reached at 307-754-7257.)