HJBR May/Jun 2023

HEALTHCARE JOURNAL OF BATON ROUGE I  MAY / JUN 2023 57 William Varnado, MD Medical Oncologist Mary Bird Perkins Cancer Center patients to provide to their primary care physician or oncologist. Once a high-risk population is defined, the next step is implementing an effective screening program. Just as treatment for pancreatic cancer is multidisciplinary, so is the potential screening process. Early suc- cessful screening focuses on patients with a family history or genetic predisposition to pancreatic cancer. Genetic counseling, MRI imaging, gastrointestinal physicians, surgeons, and medical oncologist are all in- volved in pancreatic screening programs. The most promising results for early de- tection are with an invasive endoscopic ul- trasound procedure known as EUS. This is typically performed by an experienced GI physician. The largest studies done in the U.S., the Netherlands, and Germany have shown the ability to detect pancreatic ab- normalities in high risk populations with this procedure. Deciphering these images and findings can be a bit more difficult when committing to more invasive procedures and surgeries. Interpretation of what to do with an abnormal pancreas finding should include an experienced pancreatic surgeon and an oncologist. As blood testing becomes more advanced and sensitive, there is hope that simple blood draws can lead to early detection of cancers prior to using more invasive procedures. The poor prognosis and high death rate of pancreatic cancer is attributed to many factors including the nature of the aggres- sive cancer, lack of newmedical innovations, and the advanced stage at which the disease is usually discovered. The identification of high-risk patients combined with enhanced imaging and genetic testing will hopefully lead to earlier detection of pancreatic can- cers. I encourage those in the community to modify what risk factors they can in their lives such as smoking, diabetes, and exercise. It is also crucial to understand your family cancer history. This includes other cancers such as breast, prostate, and ovarian can- cer that may be linked to pancreatic can- cer by underlying genetic abnormalities. If you feel you are at higher risk for pancreatic cancer, please inquire to your primary care or cancer center about possible screening programs that may be available. n WilliamVarnado,MD, is amedical oncologist at Mary Bird Perkins in Baton Rouge. He completed an un- dergraduate degree at Louisiana State University at Baton Rouge before going on to receive a medical degree from Louisiana State University Health Sci- ences Center at New Orleans. Varnado completed both an internal medicine internship and residency at Louisiana State University Health Baton Rouge.He also completed a hematology/oncology fellowship at BirminghamHospital System through the University of Alabama. Varnado is a member of Alpha Omega Alpha Honor Medical Society, theAmerican Society of Clinical Oncology, and the American Society of Hematology. have a genetic component. As our under- standing of the human genome grows, this number is likely to increase. Even if a spe- cific genetic mutation cannot be detected, simply having a first-degree relative with pancreas cancer increases an individual’s risk by at least twofold. Families with mul- tiple members affected are at even higher risk. Thoughmost cases cannot be attributed to one factor, there are known genetic muta- tions that are directly linked to pancreatic cancer. These mutations are also associated with multiple other cancers. The most no- table of these is the BRCA1 and BRCA2 mu- tations that have historically been linked to breast cancer. Identifying hereditary breast cancer with the detection of these muta- tions helps patients make decisions on fu- ture screening, family planning, and their course of treatment. Patients with BRCA2 mutations can have up to a sixfold increase in pancreatic cancer compared to the stan- dard population. The patients who harbor these mutations are a population that would likely benefit from early detection programs. In addition to breast and pancreatic cancer, BRCA1 and BRCA2 (along with other genet- ic alterations) have been linked to prostate cancer, melanoma, and ovarian cancer. The link of these genetic mutations to multiple cancers demonstrates why a full family his- tory of all cancers is vital information for “A 2014 meta-analysis of pre-diabetes and cancer found that even small increments of elevated blood sugar lead to increase incidence of pancreatic cancer.”