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The PancChat Podcast is a collaborative effort from Let’s Win Pancreatic Cancer and the Pancreatic Cancer Action Network (PanCAN), inspired by the long-running #PancChat Twitter/X chat.
Hosted by award-winning journalist Alisyn Camerota, each episode features conversations with leading researchers, clinicians, patients, and advocates who are shaping the future of pancreatic cancer care and research. Together, we deliver expert insights, personal journeys, and the latest breakthroughs—bridging the gap between science and lived experience.
Whether you’re a patient, caregiver, healthcare professional, or simply want to learn more, join us to connect, be inspired, and learn how you can help to accelerate progress in the fight against pancreatic cancer.
Cindy Gavin: Hi everybody, and welcome back to episode 21 of the PancChat Podcast.
I'm Cindy Gavin, CEO and co-founder of Let's Win Pancreatic Cancer. On today's podcast, we will be taking a closer look at pancreatic cancer screening and early detection.
Over to you, Alisyn.
Alisyn Camerota: Hi, everyone. I want to welcome you to today's episode of PancChat. Today, we focus on screening and surveillance for pancreatic cancer.
First, we want to thank our sponsor, Revolution Medicines.
Our guest today is Dr. Raymond Wadlow. Dr. Wadlow is a gastrointestinal oncologist who specializes in pancreatic and gastrointestinal cancers at the Inova Shah Cancer Institute in Fairfax, Virginia. He's also the director of the High Risk Pancreatic Clinic at the Inova Scharr Cancer Screening and Prevention Center and a principal investigator in the Pancreatic Cancer Early Detection Consortium, also known as PRECEDE.
Great to have you here, Dr. Wadlow.
Dr. Ray Wadlow: Thanks for having me, Alisyn. Happy to be here.
Alisyn Camerota: Looking forward to this. So we want to talk about screening and surveillance and screening versus surveillance. So, as we all know, pancreatic cancer is notoriously a late diagnosis generally. The vast majority of people only catch it when it's in a later stage. Some often stage IV, roughly eight to ten patients are already in advanced stages of the disease by the time they're diagnosed. And by then, it's too late to do anything that could be lifesaving. With pancreatic cancer, early detection would make a huge difference in a patient's lifespan.
So let's just start, doctor, with the basics. Explain the difference to us between screening and surveillance.
Dr. Ray Wadlow: Well, so Alisyn, what we really want to focus on, as you said so well, is that by the time patients develop symptoms from pancreatic cancer, the chance that they are ultimately going to succumb to that disease is over 85 percent.
The five-year survival, even in 2026, is 13%. Again, as you said, only 20% of patients are potentially candidates for surgery, and it should be emphasized that in 2026, we don't know how to cure patients with pancreatic cancer unless their care plan includes a procedure removing the tumor. But even those 20%, more than half of them will develop disease recurrence and succumb to the disease. So that means the vast majority will succumb to the disease.
So what that tells us is that we cannot wait for patients to tell us that they're not feeling well. Screening really refers to this idea that we can detect pancreatic cancer at a pre-symptomatic stage, so that we can intercept the disease at a much earlier time point, where our success rate at curing it and preventing it from causing harm and shortening the life expectancy of our patients is much, much higher. Surveillance more typically refers to monitoring somebody after they've had potentially curative, definitive treatment for a disease.
So, our patients that have had surgery for pancreatic cancer and finished chemotherapy, as medical oncologists, we then perform surveillance for at least five years thereafter. But again, that is too late in the process. We want to intercept the disease way before patients have any symptoms.
Alisyn Camerota: Okay. So let's talk about the screening at the moment. So what are the current techniques used to screen patients who are at highest risk?
Dr. Ray Wadlow: The standard of care are imaging tests, including MRI of the abdomen with special sequences of images through the pancreas and the liver and the bile ducts called an MRCP. It's part of the MRI. And endoscopic ultrasound where a gastroenterologist performs an upper endoscopy with a regular endoscope, but then also has special training using an ultrasound probe to look at the pancreas with ultrasound through the wall of the stomach.
And we alternate typically between those two procedures on an alternating annual basis. So one year, a patient who's a candidate for screening, and I'm sure we're going to talk about the criteria, would get an MRI and then the next year they would get an EUS and back and forth you would go.
Alisyn Camerota: Let's talk about the criteria since you raised it. So who do you screen?
Dr. Ray Wadlow: So right now we're interested in people with a lifetime risk of pancreatic cancer of at least in the five to ten percent range. The average person's lifetime risk is around 1% to 1.5%. And so it's a significant increase in lifetime risk. Now, patients will often say, " But that seems still quite low.”
And in one sense, it is.
But again, given the consequences of missing a diagnosis or detecting it later, you know, as we've already just discussed, the community has settled on, you know, somewhere around 5% percent as being sufficient to at least justify a conversation around screening. So who are those people?
They're people either with an inherited mutation, and there are, you know, roughly a dozen that are screened for. Some high risk enough that by themselves make an individual a candidate for screening and early detection, others requiring some degree of family history. And then there's this second category of what we call familial pancreatic cancer, where pancreatic cancer clearly is running in a family, but we can't detect an underlying genetic cause.
So the admittedly arbitrary criteria for that are somebody who has at least one first-degree relative with pancreatic cancer who in turn has at least one first-degree relative. So a parent and a grandparent on the same side or a parent and an aunt and uncle on the same side or, of course, an individual that has more than one first-degree relative, so with a history of pancreatic cancer, so a parent and a sibling or a child. Those individuals are also eligible for screening.
We would start screening typically at age 50, because even in these high-risk populations, and I should mention that some of the mutations we're looking for include BRCA1, BRCA2, ATM, PALB2, and CDKN2A, are some of the ones that we see most commonly. Typically, except for the very high-risk mutations, we would start at age 50, or, Alisyn, ten years before the earliest age of pancreatic cancer diagnosis in the family.
So if somebody meets those familial criteria that I just described, and one of the individuals in the family was diagnosed at an age younger than 60, we subtract ten years and recommend that that individual begin screening ten years prior to that.
Alisyn Camerota: That makes a lot of sense. I appreciate you spelling out those different possible mutations, but how would you know that you have one of those mutations and therefore, get screened?
Dr. Ray Wadlow: You wouldn't unless you'd had genetic testing. So the first thing we do is when when our patients are referred to Inova's high risk pancreatic clinic, and I I believe this is true of of all of the PRECEDE sites, is we try to make a determination of whether the individual should meet with a genetic counselor and have genetic testing done because that will then help us risk stratify and counsel the patients on whether they should engage in screening, how we should think about them with regard to the PRECEDE protocol, and and other conversations downstream of that.
Alisyn Camerota: So you described basically screening process, the scans, I should say, that people get the MRIs. Are there new advances, latest technology that has changed that over the past decade?
Dr. Ray Wadlow: Right. Thank you. So, the other distinction that sometimes people will make between screening and surveillance that I should also touch upon is sometimes people think of screening as a single test. I've been screened. Right? I had a test.
Whereas surveillance can also refer to a longitudinal program over time.
So that's the other way in which people may use the term surveillance. And I think that's a really important point to make because, you know, it is somewhat burdensome for people to engage in this annual screening program, right, sometimes over many, many years or decades. Right?
We would recommend that people get screened until they're no longer candidates for treatment if we find a pancreatic cancer, which at this point remains a major abdominal surgery. So, I often have a conversation with people that if we do a single test, we may be able to tell you that you don't have pancreatic cancer at this moment in time, but a true sort of screening, early detection, surveillance — I mean, at some point, these are semantics. Right? And people may have different definitions for the words. But, really, we're talking about engaging and committing to a program over time.
To get to your specific question about other technologies that are being developed, of course, because of the cost of MRI, the cost of EUS, the requirements for sedation of EUS endoscopic ultrasound, we're looking for easier, less expensive tests that eventually could be scaled to the average risk population. And, of course, those are including things like blood tests or other use of other biological specimens like stool-based testing would be another example, like we do for colon cancer now.
Alisyn Camerota: And what is the status of blood tests?
Dr. Ray Wadlow: There's a lot a lot of progress being made. So there there are blood tests, some of which are even on the market now that do a very good job of distinguishing people with known pancreatic cancer from people without pancreatic cancer, but they still need to be subjected to the rigorous validation required for these kinds of tests because even in a high risk population, a blood test that can parse out somebody with known cancer from somebody without cancer, the bar is much higher when you're using it on an individual for whom you don't know if they have cancer or not.
And negative results can be very reassuring because for some of these tests that perform very well, the likelihood of a false negative is very low. But a positive test, the likelihood of a false positive test is also very high. And we really need to be sure we know how to use these tests because if you think about it from the perspective of a patient, they come in, we suggest, oh, let's get a blood test. We get the blood test. It's positive. Okay. Now we get an MRI or an endoscopic ultrasound, and we don't see anything.
We really need to have a validated plan for surveillance and monitoring going forward because it, right now, leaves that individual in the very uncomfortable position of not fully knowing whether the test was truly false positive or whether it might be picking up something that we otherwise don't know how to see.
Alisyn Camerota: Makes total sense. And so the blood tests, as they currently exist, tell you if you have a cancer or they tell you if you have pancreatic cancer?
Dr. Ray Wadlow: There are different kinds of tests. So what I'm talking about are the pancreatic cancer specific tests in development. There are also, I'm getting a lot of press, these multi-cancer detection tests, multi-cancer early detection tests that screen for many different kinds of cancer. Those are completely different.
They have many of the same problems, though.
They continue to be studied in clinical trials because they really need to be associated with a downstream diagnostic plan so that when they come back positive, we can quickly get patients to the right diagnosis and treatment, minimizing the stress of the waiting period and false positive results.
Alisyn Camerota: Makes perfect sense. Yeah. Are there obstacles that currently prevent someone from being screened for early detection?
Dr. Ray Wadlow: Well, for pancreatic cancer, I think one of the major obstacles is awareness. Right? You know, if you ask most people, even people that are in health care and in medicine, is there a screening test for pancreatic cancer? The answer would be no because there's not for the average risk population. We don't — it's not part of standard recommendations if you're at average risk of pancreatic cancer.
So there's still the dissemination of up-to-date information about recommendations, who's at high risk, who should be offered genetic counseling and genetic testing based on their family history. And the answer for that is anyone, certainly with a family history of a first-degree relative, and oftentimes we would argue a second-degree relative as well, should consider having genetic testing, unless they know that their relative had genetic testing and that they were negative. Right? So that then will allow us to risk-stratify. So I think public awareness is a major obstacle, and then access.
Right? So these screening protocols are best done in centers that specialize in this, that are doing research, that are in communication with each other, and that's really the strength of the PRECEDE consortium — is the network and the constant sort of collaboration between now 64 sites, I believe, is the latest number and rising, around the world to really pool our resources, led by our patients who consent to have their data shared in the PRECEDE database to, number one, prove that screening saves lives at a global scale and to answer a lot of these research questions that you and I have been discussing. But even with 64 sites around the world, there are large areas where it's not that easy to access a place that is comfortable ordering and supervising pancreatic cancer screening.
Alisyn Camerota: That makes sense. Speaking of research in these programs, is there a way for patients to get involved? Do you look for patients to get involved in these different studies?
Dr. Ray Wadlow: Absolutely. So PRECEDE has a public-facing website, precedestudy.org, that is very patient-friendly, and there's a link with a map to the different sites, so that patients can — you know, because we often have patients who have siblings or family members with the same or similar risk profiles who want to get screened, they live in a different part of the country.
It's very easy now to find the nearest PRECEDE site and direct them to that institution for a consideration of screening. And then, ultimately, it's our patients who make this all possible. So I have found that because a conversation we have to have with every patient is that the decision to screen is really a different decision than to be part of the research consortium and the study, because screening, as standard of care, if an individual meets high-risk criteria, is billed through insurance. Right?
And then, as we all know, even if a test is covered by insurance, there are still costs that are passed on to the patient — deductibles, coinsurance, co-pays, whatever. And so I explain that to patients, and then the decision to participate in the study is basically patients saying to us, I want to help you solve this problem so that we can find this disease earlier and hopefully save many more lives.
Alisyn Camerota: Yeah. That is all very good information. I often am asked by friends who have lost somebody through pancreatic cancer — I lost my husband — what we should do about our children and when we start screening our children.
And so a study like this could be great. But again, there's no point in doing it if they're in their 20s. You would recommend 40s, something like that.
Dr. Ray Wadlow: Yeah. Unless there was a particularly early diagnosis in the family and we'd use that ten-year rule. Right now, we know that even in high-risk populations, we really don't see pancreatic cancer in most, certainly not in all, and that's an active area of investigation for PRECEDE — predicting earlier onset. But the population trends tell us that most of the time when we find it, it's in individuals after the age of 60. And so why ten years beforehand? It just seems like a good conservative, long time to give us a fighting chance of finding it.
Alisyn Camerota: Yeah. Dr. Wadlow, what else? What have we missed?
Dr. Ray Wadlow: I think there's some concern about what we call interval cancers. If we're screening somebody, how do we know that once a year is enough? Are there examples of patients who've been screened every year and yet who've been diagnosed with later-stage cancer in between screening time points? And we definitely see that.
Alisyn Camerota: And why is that? Just help me understand that. Why, if you're screening every year, would they have a late-stage cancer?
Dr. Ray Wadlow: Great question. So that we're working on right now. We have hypotheses that they can fit into one of certain different categories.
One answer might be they have a biologically just aggressive tumor that developed and became late stage at a shorter time period than one year. And, of course, we want to learn as much as possible from those people so that we can predict who they're going to be in the future and screen those individuals more frequently, which makes the demand for easier, less expensive, less invasive tests even more pressing. Right? Because if you've committed to do these tests every year and now I ask you to do them every six months or every three months, at some point, it becomes just not feasible. So, or at least it would be a lot easier if it were a blood or, you know, a test that didn't require MRI or endoscopy.
Other possibilities — this is a real-world study, and, you know, no test is perfect. Some of these findings that we're trying to identify are incredibly subtle, like very subtle changes in the pancreatic architecture in the duct that, you know, it's not a mass and not a tumor. And to really find those, you know, it takes a lot of practice and a lot of expertise, and they can be missed. Others could be that the quality of the study wasn't quite good enough, that the images, you know, due to any one of a number of causes, might have left us wishing for a slightly better MRI in retrospect or EUS. Right? There's operator dependence with the EUS.
It does really require a lot of experience and training on the part of the gastroenterologist.
And then, you know, in the real world, sometimes people don't get their scans every year. You know, it's now been six years, but everybody remembers the global pandemic, and there were a lot of people where it was just very difficult to get their screening done on time, and other things happen. Missing that screening interval is another reason why we see these late-stage cancers.
Alisyn Camerota: Okay. And so, back to what have we missed that you'd like to hit on?
Dr. Ray Wadlow: I think, well, the take-home message is that I really believe that PRECEDE is the right way to go about working together at an international scale to substantially and significantly reduce the number of people that will die from pancreatic cancer in the relatively near future.
I'm a medical oncologist. I treat a lot of people with advanced-stage pancreatic cancer. I do that — I've been doing that for almost 20 years. And I'm very, very excited about the new drugs and the new molecularly tailored strategies that are coming out for those people and their potential, moving them back into earlier stages of disease.
But ultimately, I think until we figure out how to prevent this disease from ever occurring in the first place, finding it when it is the earliest possible stage, either an incipient cancer that hasn't yet become a full-fledged cancer or a tiny, one-centimeter-or-less stage I cancer through sophisticated, perhaps AI-assisted technologies, is really going to be the way that we make substantial progress.
Alisyn Camerota: And we're going to be talking about that in an upcoming episode of PancChat. So thank you very much for setting the table so perfectly there. Dr. Raymond Wadlow, thanks for all the information. Really great to talk to you.
Dr. Ray Wadlow: You're very welcome, Alisyn. I really enjoyed it. Thanks for having me.
Alisyn Camerota: Me too. We also want to thank again our sponsor, Revolution Medicines, and all of our listeners for tuning into this episode.
I'm Alisyn Camerota, and I'll see you next time.
Julie Fleshman: Hi, I'm Julie Fleshman, President and CEO of PanCAN. If you or a loved one has been diagnosed with pancreatic cancer, navigating this journey can feel overwhelming, but you don't have to do it alone. Be sure to explore resources available to everyone on early screening and surveillance. You can find more information at pancan.org and letswinpc.org. Together, PanCAN and Let's Win are committed to guiding you through every step of the pancreatic cancer journey, offering support, information, and hope.
In our next episode, we'll be speaking with Dr. Elliot Fishman about the emerging role of AI in radiology and early detection. Don't forget to follow PancChat to get new episodes delivered twice a month right in your podcast feed. PancChat is available on all major platforms wherever you get your podcasts.