A recent analysis of pancreatic cancer statistics in the United States has found that the incidence of pancreatic cancer is increasing faster in younger adults than among older adults. Though this finding is cause for further investigation, the incidence overall remains low.
“This is still a rare cancer in young people,” says Asaf Maoz, MD, a physician in the Division of Genetics and Prevention and the Gastrointestinal Cancer Treatment Center at Dana-Farber Cancer Institute. Pancreatic cancer accounts for about 3% of cancer diagnoses in the United States. Among people younger than 50 it is rare, with an incidence of less than 2 per 100,000 people.
The 2023 analysis reports that between the years 2001 and 2018, incidence for people younger than 55 increased by 1.29 percent compared to a 1.11 percent rise for individuals older than 55. Behind this trend is a disproportionate increase in the number of pancreatic cancers in young people who are assigned female at birth (2.36 percent compared to 0.62 percent in individual assigned male at birth).
Why are pancreatic cancer rates rising?
In addition to young-onset pancreatic cancer, young-onset colorectal cancer (another gastrointestinal cancer) rates are rising. Research is ongoing at both the Young-Onset Colorectal Cancer Center and Hale Family Center for Pancreatic Research to understand why this happening and how best to address it.
Because these increases are associated with the period in which people were born, it is thought that they may be related to environmental or lifestyle factors. Some pancreatic cancer risk factors include chronic pancreatitis, smoking, excessive alcohol consumption, diabetes, and obesity. Whether and how environmental factors play a role is being studied.
Individuals with a strong family history of cancer or a genetic predisposition to it are also at risk for young-onset cancers. It is recommended that all people with pancreatic cancer, especially young adults, pursue genetic testing.
Will this impact pancreatic cancer screening?
Early detection of pancreatic cancer remains a challenge. With the estimated risk of developing it over a lifetime at 1 in 100, the United States Prevention Service Task Force does not recommend screening. At this point, researchers don’t believe the trend requires a change in screening recommendations.
For now, only certain people at high-risk are recommended to pursue screening. These may be individuals with a strong family history of pancreatic cancer, or individuals who have a known inherited genetic predisposition to pancreatic cancer. This includes those with inherited “mutations” (a harmful change in DNA) in the BRCA 2 and ATM genes, among others.
Screening for these individuals involves annual magnetic resonance cholangiopancreatography (MRCP), an endoscopic ultrasound (EUS), or some combination of the two. MRCPs are a special kind of MRI used to look at the pancreas, liver, and other organs. EUS combines endoscopy and ultrasound to examine the digestive tract.
Dana-Farber researchers Michael Rosenthal, MD, PhD, Brian Wolpin, MD, MPH, and Matthew Yurgelun, MD, FASCO, CGAF, are studying how pancreatic cancer may be detected early, including using bloodwork.
“This is a major question in the field,” says Maoz. “Blood tests are more accessible and scalable and are less dependent on who is interpreting the scan or operating the ultrasound, but we don’t know how to incorporate them into screening yet.”
Genetic research may unlock answers
Genetic testing may be key for addressing pancreatic cancer in young adults. Researchers estimate that between 25 and 30 percent of early onset pancreatic cancer cases occur in individuals with a germline mutation. This may offer a route to early detection, a key to improving survival for all patients with pancreatic cancer.
One large study involving Dana-Farber, the Cancer of the Pancreas Screening Study (CAPS), provides evidence that screening for high-risk individuals can be effective. Those who were screened had an average survival rate of 10 years, and over 70 percent of those who developed pancreatic cancer were diagnosed at an early stage. Without screening, cancers were caught at the metastatic stage over 80 percent of the time.
The study was not randomized, Maoz observes, but “it was a striking difference.”
However, while patients diagnosed with pancreatic cancer at Dana-Farber are offered genetics counseling and germline genetic testing by the Division of Genetics and Prevention, many people in the United States do not have the same access.
One approach to expanding genetic testing availability is being explored through Dana-Farber’s VERDI (Video Education with Result Dependent dIsclosure) trial. Investigators hope to determine whether patients can receive effective pre-genetic counseling through an educational video. Individuals would only have to pursue a genetic counselor visit if their results were positive, potentially expanding access to genetic testing while providing patients with all the information they need to make decisions about their care.
Ultimately, despite these newly discovered trends, the majority of young adults are not at high risk for developing pancreatic cancer. Still, symptoms (including stomach pain, weight loss, jaundice, and more) should be taken seriously. Studies suggest that young adults with cancer often experience delays in establishing their diagnosis and receiving medical care.
“Gastrointestinal cancer is uncommon among young adults but being young does not mean you cannot develop cancer,” Maoz explains. “If you’re having symptoms, it is important to speak with your doctor and determine what the appropriate work up is.”
About the Medical Reviewer
Dr. Maoz is an attending physician in the Division of Genetics and Prevention and the Gastrointestinal Cancer Center at Dana-Farber Cancer Institute, and a member of the faculty at Harvard Medical School. He received his undergraduate degree, Summa Cum Laude, and his medical degree from the Hebrew University. Dr. Maoz trained in Internal Medicine at Boston University, where he was inducted into the Alpha Omega Alpha Honor society. He then pursued fellowship training in Oncology at Dana-Farber/Mass General Brigham. He also completed postdoctoral fellowships at the University of Southern California, and the Whitehead Institute for Biomedical Research. Dr. Maoz's research focuses on the detection and prevention of hereditary cancers and the treatment of cancers of the gastrointestinal tract.