Earlier Diagnosis of Pancreatic Cancer: Is It Possible?

SIMPLE SUMMARY: Pancreatic cancer incidence is increasing yearly. The reasons are not well known. Unfortunately, this is one of the least treatable cancers. Standard chemotherapy treatments show poor results, as do targeted treatments. The only real improvement in pancreatic cancer in the last twenty years occurred in the surgical field, where neoadjuvant therapy and very early surgery have achieved better overall survival. The only secret of arriving early to surgery is early diagnosis, and the missing element for early diagnosis is screening. This paper discusses the population that needs to be screened. ABSTRACT: Pancreatic ductal adenocarcinoma has a very high mortality rate which has been only minimally improved in the last 30 years. This high mortality is closely related to late diagnosis, which is usually made when the tumor is large and has extensively infiltrated neighboring tissues or distant metastases are already present. This is a paradoxical situation for a tumor that requires nearly 15 years to develop since the first founding mutation. Response to chemotherapy under such late circumstances is poor, resistance is frequent, and prolongation of survival is almost negligible. Early surgery has been, and still is, the only approach with a slightly better outcome. Unfortunately, the relapse percentage after surgery is still very high. In fact, early surgery clearly requires early diagnosis. Despite all the advances in diagnostic methods, the available tools for improving these results are scarce. Serum tumor markers permit a late diagnosis, but their contribution to an improved therapeutic result is very limited. On the other hand, effective screening methods for high-risk populations have not been fully developed as yet. This paper discusses the difficulties of early diagnosis, evaluates whether the available diagnostic tools are adequate, and proposes some simple and not-so-simple measures to improve it.