Ahead of World Pancreatic Cancer Day, Professor Matthias Löhr, a member of the UEG Public Affairs Committee, explains why we must increase pancreatic cancer awareness
On November 21, 2019, United European Gastroenterology (UEG) and Pancreatic Cancer Europe (PCE) will recognise World Pancreatic Cancer Day.
Over the past 50 years, diagnosis and treatment strategies for cancer patients have evolved rapidly but despite the major advancements, improvements in pancreatic cancer patient outcomes have largely stood still. The overall 5-year survival rate for patients diagnosed with pancreatic cancer is just 5% across the globe, a figure that has not significantly improved since the 1970s.[i]
A recent study presented at UEG Week Barcelona 2019 revealed that as well as an increase in pancreatic cancer cases, the number of deaths attributable to the disease has risen from 196,000 in 1990 to 448,000 in 2017.[ii]
Whilst a proportion of this increase can be explained by a rising population and increased life-expectancy, age-standardised incidence and death rates for pancreatic cancer had still risen by 12% and 10% respectively over the course of the study.[iii]
What is the cause of pancreatic cancer?
Whilst the precise cause of pancreatic cancer remains unknown, a number of factors have been linked to the development of the disease including obesity, which has been shown to increase a patient’s risk of pancreatic cancer by almost 47%.[iv]
Recent forecasts have predicted that both the number of cases and deaths will increase by 40% by 2035 if preventative measures are not taken.[v] With an estimated two-thirds of the risk factors being categorised as potentially modifiable, there is a huge opportunity for both clinicians and the public to promote and partake in lifestyle changes that can significantly reduce the risk of the disease.[vi]
Silent symptoms
However, a number of pressing challenges still face clinicians and the general public in the identification and treatment of pancreatic cancer. In the earliest stages of the disease, symptoms are often silent or general, making pancreatic cancer a notoriously difficult disease to diagnose.
Perpetuating this problem further, poor public awareness of pancreatic cancer and the absence of a standard diagnostic tool frequently causes delays in identification, allowing the cancer to remain present in the body for many years prior to detection.
As a result, only 10-20% of cases are identified in time for curative surgery.[vii] For those who are not diagnosed in time for resection, violent tumours can persist, which display extreme resistance to treatment, partially explaining the incredibly low survival rates associated with pancreatic cancer.
A new era of treatment
Despite these statistics, recent progress has provided hope for the future of pancreatic cancer patients as a number of improvements have been seen across the field, including the increased efficacy of a range of treatment options.
Traditionally, surgery, chemotherapy and radiation therapy have been the most commonly used tools however, the advent of immunotherapy could signify a new frontier for pancreatic cancer treatment.
Recent studies have suggested that combination treatment strategies in conjunction with immunotherapy could potentially yield positive results, improving pancreatic cancer prognosis.[viii]
Research funding in Europe
European funding for the disease lies far behind many other cancers with similar mortality rates, receiving less than 2% of all cancer research funding in Europe.[ix] An increased allocation of EU funds to pancreatic cancer research will allow for the exploration of a number of different treatment options.
The Cancer Moonshot programme
The Cancer Moonshot programme, a project launched across the US with the aim of reducing mortality rates in several major cancers, represents a promising new development in pancreatic cancer research.
The resultant Precision PromiseSM, an adaptive randomized clinical trial platform, allows researchers to evaluate multiple novel therapies to develop effective and groundbreaking treatment options for pancreatic cancer.[x]
The implementation of similar projects across Europe and the wider world should be seen as an essential step in improving pancreatic cancer outcomes across Europe.
The future: Raising awareness
Solving the persistently difficult question of how to improve pancreatic cancer care will ultimately require not only the allocation of funds to the field, but a coordinated approach from all areas of society, including the public, academia and industry.
Improving awareness of the disease amongst the public, encouraging researchers to enter the field and apply for grants, and incentivising drug companies to focus on drug development, are all crucial steps we need to take if we are to change the course of this destructive and often overlooked disease.
References:
[i] Malekzadeh, R. et al (2019). The global, regional and national burden of pancreatic cancer and its attributable risk factors in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Published in The Lancet Gastroenterology and Hepatology.
[ii] Malekzadeh, R. et al (2019). The global, regional and national burden of pancreatic cancer and its attributable risk factors in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Published in The Lancet Gastroenterology and Hepatology.
[iii] Malekzadeh, R. et al (2019). The global, regional and national burden of pancreatic cancer and its attributable risk factors in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Published in The Lancet Gastroenterology and Hepatology.
[iv] Pancreatic Cancer Action Network. (2018). 16 Pancreatic Cancer Warning Signs Infographic. Available: https://www.pancan.org/spread-the-word/16-pancreatic-cancer-warning-signsinfographic/. Last accessed October 26 2019.
[v] World Health Organization. (2018). CANCER TOMORROW. Available: http://globocan.iarc.fr/Pages/ burden_sel.aspx Last Accessed October 26 2019.
[vi] Iodice, S., Gandini, S., Maisonneuve, P., Lowenfels A, B. (2008). Tobacco and the risk of pancreatic cancer: a review and meta-analysis. Send to Langenbecks Arch Surg. 393 (4), 535-545.
[vii] Yamamoto, T et al (2015). Long-term survival after resection of pancreatic cancer. A single-center retrospective analysis. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4284344/. Last Accessed October 26 2019.
[viii] Torphy, R et al (2018). Immunotherapy for pancreatic cancer. Barriers and breakthroughs. Available at:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6036358/. Last Accessed October 26 2019.
[ix] Pancreatic Cancer Research Fund. WHY WE EXIST. Available at: http://www.pcrf.org.uk/pages/why-we-exist.html. Last Accessed October 26 2019. –
[x] Pancreatic Cancer Action Network. Precision PromiseSM. Available at: https://www.pancan.org/research/precision-promise/. Last Accessed November 12 2019.
