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  • Writer's pictureDr. Robert A. Nagourney, MD

What’s a Pancreatic Cancer Doctor to do? More Importantly: What are Their Patients to do?

Screening for Pancreatic cancer, even in the highest-risk individuals found not cost effective.

According to a large study conducted by investigators at Harvard University, (Peters, MLB J Clin Oncol, February 2024) the available techniques used to screen for early stage (curable) pancreatic cancer including genomic tests, MRI and endoscopy are not cost effective.

Using a microsimulation model applied to individuals at the highest risk for this lethal disease, the cost to save one life using these genetically identified individuals went as high at $404,000/year of life saved. Contemporary re-imbursement allowances from insurers, Medicare and others use a cut-off of $100,000/year of life saved, less than one fourth of this figure.

The most widely recognized DNA mutations known to predispose individuals to pancreatic cancer include BRCA1, BRCA2, ATM, Lynch syndrome and others. However, not one of these met the standard.  Two DNA mutations that did manage to cross the threshold are the relatively rare CDKN2A and STK11.

The take home message is that contemporary gene tests have no meaningful impact on cancer detection in most patients and when they are applied, they fail to guide even the highest risk individuals to better outcomes at a cost that our society can or is willing to pay.

Interestingly, the one gene that absolutely met the threshold, head and shoulders above the others, was STK11. So what is STK11? Well it is a  gene that codes for an enzyme known as a serine-threonine kinase that is fundamental to human nutrition and metabolism.

That’s right; the one DNA finding that has better than a “snowballs’ chance in hell” of finding your pancreatic cancer early enough to save your life is metabolic.

In this context the manuscript that we published this week in the journal Metabolites (D’Amora P, et al Metabolites, February 2024) that used metabolic measures in the blood showed that it can find pancreatic cancers earlier and better than any other test, and now offers the first real chance for patients who want to find their pancreatic cancers the opportunity to do so before it is too late.

Billions of dollars have been spent on genomic analyses. Yet, these highly touted tests offer no insights that can be translated into better outcomes.

Physicians and patients need to broaden their horizons when it comes to cancer detection and treatment. Metabolomics is the next “omic” in cancer medicine.    


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