There is no good early-screening tool for pancreatic cancer

DEAR DR. ROACH: It is my understanding that there is no early-screening test for pancreatic cancer and it is typically not diagnosed until it is very advanced, hence the high mortality rate. My late loved one’s case was confirmed only after having a CT scan; not even an MRI revealed the tumours. A prominent person’s case was found early enough to be successfully treated only because she was a colon cancer survivor and a routine CT scan that was done as part of her follow-up revealed an early and treatable tumour in her pancreas. Why can’t CT scans be done routinely to check for pancreatic tumours? — S.C.

ANSWER: It’s a very good question, and one I am often asked, not only about cancer of the pancreas but also about ovarian cancer. The answer is that pancreatic cancer is uncommon (one to two people per 10,000 per year), and there are very few cases where the cancer can be found early enough to make a difference.

Every study done so far on screening for pancreatic cancer has shown no reduction in the rate of death from pancreatic cancer. Even when found early by CT, ultrasound or blood testing, it usually is already too late for most. While I rejoice for Justice Ruth Bader Ginsburg, to whom I think you refer, she was one of the lucky few.

A reasonable follow-up might be: even if screening only saves a few people, isn’t it worth doing? Unfortunately, there are downsides to screening. There are dollar costs of the tests. CT scans in particular have radiation, which if repeated, over time can increase the risk of developing other kinds of cancers.

More importantly, scans can show findings that appear to be cancer or another abnormality, but on surgical biopsy turn out to be nothing important. This causes people to be operated on unnecessarily. So far, the harms of screening, even though they seem small, outweigh the much smaller chance of finding a curable cancer.

It is possible that breakthroughs in treatment will lead to a new era for pancreatic cancer, where formerly incurable disease can be successfully treated. If (hopefully when) that happens, screening then may be re-evaluated.

I should note that this discussion applies to people with no known risk factors for pancreatic cancer. Perhaps 10 to 15 per cent of pancreatic cancer has a familial component. People with a strong family history of pancreatic cancer or those with a genetic condition that predisposes to pancreatic cancer (such as BRCA2 or BRCA1) should consider enrolling in a study or finding a centre with expertise in screening highrisk people for pancreatic cancer, where testing is more likely to have benefit.

DEAR DR. ROACH: I have mandibular tori. What in the world got this started? Was it medication or something catching, like from the dentist? I am 92 and don’t want it to get worse. — I.L.

ANSWER: The mandible is the lower jaw, and a torus is a bony growth. They usually are present on both sides, so they are called tori. A torus also can be present on the hard palate. They may grow slowly over time.

It’s not clear where they come from, but they are more common in men and in people who grind their teeth, so they are thought to arise from stress in the bone. They are of no concern and do not need to be treated unless they are bothering you. Occasionally they get so big that they interfere with eating or speech. If that’s the case, they can be treated surgically. Tori are quite common, but I have never referred a patient with a torus for surgery.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, Fla., 32803.