EPI is one cause of pancreatic cancer

Dear Dr. Roach: Recently I was diagnosed with exocrine pancreatic insufficiency after symptoms of unexpected and sustained diarrhea for three months. I was also diagnosed with NAFLD (nonalcoholic fatty liver disease) last November. A year ago, I first noticed slight weight loss and decreased energy. I underwent a stool exam that showed below normal elastase (189 vs. 200 being the low end of normal). I worry about pancreatic cancer. Recently I had two friends die of pancreatic cancer. I just can’t seem to get past the worry that I may have it. What do you suggest?

D.C.

Answer: There are several conditions that can cause exocrine pancreatic insufficiency. In my career, virtually all of the cases I have seen were due to recurrent episodes of pancreatitis, from alcohol or stones. However, cystic fibrosis and surgical removal of part of the pancreas, stomach or intestines can also lead to EPI, along with a few other rarer conditions. Pancreatic cancer is one cause of EPI. Because you haven’t identified any other cause of EPI and have had some weight loss, I would think a scan (CT or MRI) to look for pancreatic cancer or other structural pancreas problems would be prudent.

Dear Dr. Roach: Is there an age limit where it is no longer necessary to have a mammogram or a colonoscopy? I’m 87 and having a debate with my daughters.

M.A.G.

Answer: Screening tests are performed on people with no symptoms in order to prevent problems later in life. There is always a cost of performing these tests. I don’t mean just the dollar costs, but rather the potential for harm that can come from the test itself as well as from the follow-up procedures that may be required.

Balancing against these risks is the possibility of benefit. But there is always the trade-off between risk of harm now against possibility of benefit later. As people become older, the benefits “later” become less and the harms “now” tend to increase.

There is no defined or accepted age cutoff for these procedures, but for most people, the benefits and harms start to become about equal around age 75.

No experts recommend these screening tests beyond age 85.