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• Posted November 19, 2024

Why Alarm Is Easing Over a Rise in Pancreatic Cancer Among the Young

Experts have been concerned by rising rates of pancreatic cancer in young adults, but new research reveals the jump in cases has not been accompanied by any increase in deaths from the disease.

Why? According to the scientists behind the finding, today's more highly sensitive imaging scans may be catching early, nonlethal cases of pancreatic cancer in people under 40 that were simply missed before.

"Reports from several registries have garnered concerns over the increasing incidence of pancreatic cancer among younger persons, particularly women in the United States and globally," the researchers wrote in their report. "Although some attribute this trend to increasing rates of obesity, others have found no obvious cause."

But when the team drilled down on the data, they came to a surprising conclusion: It turns out that statistics on pancreatic cancer lump together two very different types of tumors that happen to emerge in the same organ -- endocrine cancers and adenocarcinomas.

The first type tends to take years to grow and spread, while the second is typically fast-moving and aggressive.

"The increasing incidence of pancreatic cancer in younger Americans is primarily due to increased detection of smaller, early-stage endocrine cancer -- not an increase in pancreatic adenocarcinoma," the researchers wrote.

So the fact that new cases of pancreatic cancer are rising while deaths are not, "suggests that the recent increase in early-onset pancreatic cancer reflects detection of previously undetected disease, rather than a true increase in cancer occurrence."

In the study published Monday in the Annals of Internal Medicine, researchers led by Dr. Vishal Patel, a surgical resident at Brigham and Women’s Hospital in Boston, did not not argue that cases of pancreatic cancer are indeed rising among the young: Data from 2001 to 2019 showed that the number of pancreatic cancer surgeries among people between the ages of 15 and 39 has roughly doubled in women and men.

Interestingly, the increase was confined to cancers that were in the very early stages. That finding points to a phenomenon known as overdiagnosis: a rise in incidence without a linked rise in deaths.

More lethal adenocarcinomas are sometimes discovered early, when they surface in abdominal scans done for other reasons. But the incidence of adenocarcinomas at every stage has remained stable in young people, the study authors noted.

Meanwhile, less harmful endocrine tumors are being detected on the pancreas by increasingly sensitive CT scans or MRIs, which are being used for various purposes more often than before, the researchers explained.

“The more you are imaged, the more these things will turn up,” study author Dr. H. Gilbert Welch, a senior researcher in the Center for Surgery and Public Health at Brigham and Women’s Hospital, told the New York Times.

And once something is discovered, doctors and patients alike may feel they need to act.

“Sometimes we see things on imaging and we have to go after it,” Dr. Folasade May, a gastroenterologist at the University of California, Los Angeles, told the Times. “People might end up with a big surgery. But it is hard to tell who needs the surgery and who doesn’t.”

The doubling of such surgeries in young people with pancreatic cancer suggests that many are having that operation.

“A lot of patients say, ‘Get it out,’” study author Dr. Adewole Adamson, an overdiagnosis expert at the University of Texas at Austin. “When someone tells you that you have cancer, you feel like you have to do something.”

What should doctors and patients know going forward?

"Pancreatic cancer now can be another cancer subject to overdiagnosis: the detection of disease not destined to cause symptoms or death," the researchers wrote. "Overdiagnosis is especially concerning for pancreatic cancer, as pancreatic surgery has substantial risk for morbidity... and mortality."

More information

The University of Pennsylvania has more on pancreatic cancer.

SOURCE: Annals of Internal Medicine, Nov. 19, 2024; New York Times