As I write this, the world is in the midst of the COVID-19 pandemic. People are focused on disease prevention to a degree not seen in a century. The public understands the need for preventive measures and has taken extraordinary steps trying to prevent the spread of COVID-19. We are seeing public health prevention working. Pancreatic cancer needs a public health intervention too.
The ComPARe study shows us what the future burden of cancer in Canada could be and gives us insight into methods we can collectively use to reduce cancer burden. Similar to COVID-19, a public health preventive approach is needed to reduce pancreatic cancer burden because there is currently no effective treatment for many patients.
When we think of pancreatic cancer we do not naturally think of prevention. This is reserved for other cancers like melanoma and lung cancer, in which clear prevention methods like avoiding UV light and smoking cessation are well known. Yet the ComPARe data shows us that modification of known risk factors could reduce pancreatic cancer incidence by 22% and potentially up to 41% when known and suspected risk factors are combined. In a disease like pancreatic cancer with poor response to treatment, prevention is an important strategy.
Pancreatic cancer is now the 3rd leading cause of cancer-related death in Canada despite being 12th in incidence. This is very different from common cancers like prostate and breast, which have much higher 5-year survival (8% for pancreatic vs 88% for breast and 93% for prostate). Prevention of disease is always important, but it is particularly important when treatment options are limited and not effective.
Modern medicine simply is not very good at treating pancreatic cancer. This is why survival is so low. People who present with stage 4 pancreatic cancer are typically not curable. Even for people with early stage pancreatic cancer, which is usually treated with surgery, the median survival is a little more than 2 years.
Given this lack of effective treatment and the low survival rate, prevention is all the more important in reducing the burden of pancreatic cancer. We know what the risk factors are – smoking tobacco, drinking alcohol and having excess body weight. A renewed focus on managing these risks is needed to address this 3rd leading cause of cancer death in Canada.
Alex Mathieson, MD, FRCSC
General Surgery and Surgical Oncology
Associate Professor of Surgery