That would be something worthwhile to ask your oncologist.
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Totally agree with your point about the risks of overtreating!
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I already asked my oncologist about Signatera.
Signatera – Circulating Tumor DNA Blood Test | Natera
They don’t do any testing of this kind unless metastasis has been identified. If I have unusual pain, they refer me to PCP for x-ray.
I found a genomic test to evaluate benefit from extending hormonal treatment for my breast cancer, through breastcancer.org, and had my doctor do the paperwork. They now use that test in their practice. But not these screening tests.
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This is a valid point. I think development of the blood-based “early” cancer detection tests is going to trend towards trying to differentiate between these indolent cancers and the ones that are aggressive and grow/metastasize quickly. There are so many companies in the mix now developing these tests.
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You may find this article from MD Anderson interesting. It talks about investigating whether screening for CA19-9 in people with a high risk for pancreatic cancer could be useful. CA19-9 is a fairly inexpensive blood test.
The caveats are that there is a normal range for healthy people, and other non-cancerous conditions can cause elevated levels. But it may still be promising.
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Well, again, the real proof will be if pancreatic death rates go down - not if more early cases are found and treated. Too often we use the wrong measure —
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Problem is, if pancreatic cancer death rates go down, they may not know exactly why. Is it better treatment, earlier detection, or less lifestyle risks? I certainly would want it treated early if I had it.
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Those factors can be statistically accounted for if a sample is large enough.
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Personally, though, I don’t see a downside to detecting pancreatic cancer earlier then the usual Stage 4 that it’s most often noticed at. Particularly if you’re at risk. I don’t know that I want to wait for large scale studies that tell me if early detection is working or not.
The more earlier cases we can detect, the bigger the population for trying new treatments will be. This hopefully can lead to discoveries of new treatments and better outcomes for the patients in the long run.
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If cost of a specific type of screening and detection is high per life saved, then the same money can save more lives with some other medical action.
Also, if the false positive rate is high, and subsequent diagnostic actions may risk harm (i.e. be invasive or use significant radiation), then the harms caused in false positives need to be accounted for.
I don’t think it works like that in reality. It’s not like there is just one pot of money that is applied to the actions that save the most lives. If it was, we’d put much of our money into making tobacco illegal and very little into the endless and expensive money pit of end of life care. And this specific screening I was interested in, the Galleri test, is paid for by the patient.
The Galleri test has high sensitivity for more aggressive cancers, such as pancreatic cancer, which tend to release more cell-free DNA into the bloodstream at early stages and are more likely to be detected. They claim that, "Higher Galleri sensitivity for the deadliest cancers helps minimize overdiagnosis and/or overtreatment of indolent cancers. Galleri has high sensitivity (76.3%) for 12 deadly cancers that comprise two-thirds of all cancer deaths. It has 83.7% sensitivity for pancreatic cancer, which is the one that most concerns me.
I am interested in the other testing options that people are putting on this forum also. It does seem to me that if you can test with relatively accurate results for the most deadly cancers, follow them up and treat them before they become Stage 4, it’s worth doing.
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I am going to do this! Thank you for the information you PM’d to me. This is super cheap ($43.95), and I don’t even have to order it through my doctor, I can just schedule it at one of Ulta Lab’s patient centers near by. Very good information, thank you!
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You’re welcome!!
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On October 30, I had my D2 drive me to an ER with terrible abdominal pain and prolific vomiting. I NEVER throw up. The last time I’d ever thrown up was in 1987 after some very poor choices at a bar. Oops!
They did a CT scan, which diagnosed appendicitis, and I was literally rushed off to surgery. Everything went fine.
A couple of weeks later, I dove into my portal and saw the CT report. Buried in there was a reference to a “lesion” in my pancreas that probably should be evaluated. I couldn’t believe what I was reading, because NO ONE had mentioned this to me during my hospitalization.
Long story short, my new Nurse Practioner had by coincidence been to a presentation at UT Southwestern Pancreatic Cancer Prevention Clinic, and she said “I’m going to submit your case to them pronto.” Because my lesion was so small (5 mm), I wasn’t scheduled for a follow up until June 12. I waited 11 days to get my results, which were that I have two tiny lesions. One had doubled in size in these last months, but it was still really small (“high risk” is 3 cm or greater, mine is 10 mm) and I have no other risk factors.
Nevertheless, I’ve been accepted to their program, and I feel really lucky that I will be monitored for the rest of my life, with yearly MRIs unless or until they see something worrisome. This cancer has always been one of my worst nightmares, because there really is no routine screening, and by the time you show symptoms, it’s usually too late. I feel like anyone who can afford to get these scans should go ahead and do it. It could save your life. Yes, there are some pancreatic tumors that are so agressive that early diagnosis won’t save you, but there’s also a chance that you could arrest something horrible in its tracks. It may turn out that my appendicitis was the best thing that ever happened to me.
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Wow. That’s incredible. And they didn’t even mention it to you. Thank God you’re a medical professional who understands and investigates these things for yourself. It so fortunate that they accepted you in the study, and that you will be monitored. Are they recommending any sort of treatment now?
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Yes, it’s great having an alert and collaborative medical professional to work with. So glad you will be well-monitored so they can know early if there’s something for them to be concerned about.
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the recommendation is to be followed by a pancreas doctor with initial recommendations for yearly MRI. I think someone will call me to discuss.
Yes, I am only beeing followed for this because I took the initiative to read through all my tests and labs in my portal. Even in the CT report it said the recommendation was to follow up on the pancreas cyst, though not one person ever mentioned it.
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I read all my medical records as well. It seems like an important thing to do and they’re readily available on electronic medical records. We really have to be our own advocates!
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I wish H’s PCP had digital records. I might have noticed that his WBC were elevated and steadily increasing for years before the ortho caught it before surgery, as H’s PCP never said a word.
@Nrdsb4 i am so sorry to hear of your diagnosis, but am glad you were on top of it.
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