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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.
Welcome to episode three of the PancChat
podcast. This episode focuses on the risk
factors for pancreatic cancer. I'm Julie Fleshman,
president and CEO of the Pancreatic Cancer Action
Network. Our host Alisyn Camerota is joined by Dr.
Anirban Maitra and Dr. Michael Goggins to discuss
this very important topic. Thank you for joining
us as we explore what puts people at higher risk
for pancreatic cancer and most importantly
how people at higher risk can be monitored.
Hello everyone, I'm Alisyn Camerota. Thanks
for joining me on PancChat. We want to thank
our sponsor Revolution Medicines for
their support. Today’s guests are Dr.
Anirban Maitra. He's an internationally
recognized pathologist in gastrointestinal
cancer research and translational oncology.
He'll be joining NYU Langone this September
from MD Anderson and he will be the new
director of the GI Cancer Center and
Associate Director of the Translational
Research at Perlmutter Cancer Center.
We also have Dr. Michael Goggins. He
is a professor of pathology, medicine,
and oncology at Johns Hopkins University. He
practices gastroenterology at Johns Hopkins
Hospital, and he is the director of the
pancreatic cancer early detection research
lab at Johns Hopkins. Both Dr. Maitra and Dr.
Goggins have been the recipients of research
grants from PanCAN. Gentlemen, it sounds like we
have the perfect guests for today's conversation.
Thank you for having us, Alisyn. Really appreciate
it. Welcome. Really looking forward to this.
Okay. So let's begin with, as I understand
it, the three main categories of risk factors
for pancreatic cancer. Those are lifestyle,
disease-related, and inherited. Dr. Maitra,
let me start with you. Can you help us understand
more about each of those three categories?
Sure. I think we've learned a lot in terms of
risk factors for this disease which unfortunately
still strikes sort of out of the blue in most
individuals. In most patients, there's not one
attributable risk factor that you can point to and
say this is what caused the cancer, except for a
minor subset, you can say this is most likely the
cause. But in most individuals who get diagnosed
with pancreas cancer, you can't say, well, for
sure we know this is what caused the disease.
Unlike for example with lung cancer and smoking
or cervical cancer and the human papilloma or HPV
virus, you can say we know this is what caused the
cancer. It's hard to do that. But with that said,
there are some risk factors that we do know
contribute to pancreatic cancer development. One
of which in terms of lifestyle is obesity. We know
this is one of the cancers that is associated with
a high body mass index. And certainly, as the rate
of obesity has gone up, so too has the incidence
of pancreatic cancer. In terms of disease-related,
I would say inflammatory conditions of the
pancreas. Most importantly, pancreatitis is a
very important risk factor. Alcohol and smoking,
which I guess are also lifestyle-related, but
do in turn cause inflammatory conditions in the
pancreas, would kind of be at that interface
of lifestyle and disease that contribute to
pancreas cancer. So obesity, pancreatitis,
smoking, alcohol are some of the big ones.
Mike, maybe you can focus on the inherited
and anything else I may have missed here.
Yeah, go ahead, Dr. Goggins.
Yes. Among inherited factors, inheritance
is also not determinative. If you have
a family history of the disease, you're at
increased risk and we can talk more about it,
but the extent of your family history matters and
how close the relatives are. Most people who get
pancreatic cancer don't have an immediate blood
relative with the disease, but having said that,
it's certainly an important risk factor, and for
pancreatic cancer, like for a variety of diseases,
some of the cancer genes people can inherit—the
BRCA genes, certain other genes—also contribute to
pancreatic cancer risk. Those are very important
factors because we can do gene tests in the clinic
now routinely and really help us understand. We
can take a detailed family history and these are
risk factors that don't change, so they're very
important to understand and we try to use these in
the clinic to decide who needs early detection. In
terms of other diseases, you can consider some of
the incidental findings on the pancreas that we'll
see—that people who have imaging abnormalities in
their pancreas that reflect precancerous changes.
Pancreatic cysts, for example, are quite common
as you get older and although they don't convey
necessarily any great risk, that's a challenge
with many of these risk factors. Some of them
are only mildly associated with risk as opposed
to being very powerfully at risk. But having
imaging abnormalities in the pancreas, that can
create concern, like pancreatic cysts, that would
be another disease. Then you could also take the
obesity question and there's diseases related to
that and there's overlap. People who have obesity
may or may not have a metabolic syndrome. They'll
hear that doctors sometimes tell their patients
they have a metabolic syndrome. Conditions that
are associated with that, like having a fatty
liver, having conditions like sleep apnea—these
are where your body's metabolism is off and
diabetes is often a disease that is associated
with pancreatic cancer risk to a certain extent.
Dr. Maitra, of those three, is there one that
you think is more determinative—lifestyle,
disease-related, or inherited? Is there
one that you pay more attention to?
Inherited is the smallest slice so to speak,
but it's the one that you cannot change,
but where you do have some mitigating factors
you can pursue, and one where physicians like Dr.
Goggins who are gastroenterologists can actually
put individuals on surveillance. So if somebody
has a particular DNA alteration or what we call a
mutation in their genes that causes them to be at
higher lifetime risk for pancreas cancer, then
you can definitely tell them: one, don't smoke,
try to reduce your alcohol intake, so don't do
the other lifestyle things that may increase that
risk. But then if this is a particular gene—and
not all the genes have the same risk of pancreas
cancer, some are only modest and others are
quite high—if you're on the higher side,
maybe talk to Dr. Goggins and see if you can
get on his surveillance program so that, heaven
forbid, in case cancer develops, we can catch
it really early or maybe even at the time it's
just getting to cancer. Because what Dr. Goggins
and others have shown is that these individuals,
when they're on these surveillance programs and
the cancer is diagnosed early, they actually
do really well—much, much better than your
run-of-the-mill community diagnosis that happens
outside of these surveillance programs. So, I'd
say the smallest slice is the inherited slice,
but it's the one where we've really made a lot
of progress. The other one, as Mike mentioned,
in terms of disease, the cystic lesions, this is
something I'm glad Mike brought up. It's becoming
an epidemic in a way that it's almost a man-made
epidemic because so many Americans are now getting
abdominal scans for unrelated reasons. I mean, you
have right abdominal pain for potential gallstone
or somebody gets into a car accident or whatever,
you get scans. There are tens of millions of scans
done every year. Some of these will pick up a
silent cyst. These cysts are little fluid-filled
bags in the pancreas that have a small, very small
risk, but a real risk of getting pancreas cancer.
And so we have tools that we can use to follow
these individuals and I would pay some attention
to those individuals as well because we have the
tools to mitigate the risk of getting to cancer in
those individuals. The lifestyle changes—alcohol,
smoking, obesity—that's really advice that you can
give and you hope that individuals will take
that advice in all seriousness and pursue it.
For example, with obesity, there are now these
GLP agonists that everybody is really excited
about. So you also have an active prescription
that you can give individuals to lose weight
and potentially mitigate the risk for pancreas
cancer. But again, these lifestyle risks—the
contribution of any individual one to pancreas
cancer is much less. It's always a cumulative
contribution over multiple things. You have
obesity, but you also smoke and you might
take more alcohol than you should, and so it all
kind of adds up. So any one given thing is hard to
necessarily reduce the lifetime risk of. But with
the hereditary conditions and the cystic lesions,
you can actually follow these patients and
do something to catch the cancer early.
Dr. Goggins, how do people get on your
surveillance list or what’s the mutation
they have to have—not just your list, but what’s
the mutation they have to have to be surveilled?
The way we've thought about this and our practice
has evolved, the pancreatic cancer early detection
community who practices this, we started out:
first, do no harm, select the people we think
are at the highest risk. Over time we've felt more
confident that what we do can make a difference.
So we enroll people with certain family history
criteria, certain gene mutation criteria, and a
certain age criteria into the hereditary programs.
There are parallel programs and they can overlap
of course as well, where people come and they get
a CT scan for something and as we were discussing,
an abnormality like a significant cyst is seen,
and then we decide maybe we should keep an eye on
that, that those are often little baby precancers
that often do need lead nowhere. So those are the
two main surveillance programs. You want a family
history that meets certain criteria—that's how
many family members, close blood relatives with
pancreatic cancer. One close blood relative with
pancreatic cancer increases your lifetime
risk modestly. We think the lifetime risk
is under 2% for pancreatic cancer. If you have
a family member, even one close blood relative,
that may double the risk or so. If it's a young
onset pancreatic cancer, maybe even a little
more so. We think about people even when they
have one first relative, although most people,
we think maybe they're not eligible. Usually we
start surveillance at middle age. If you have two
first group relatives or you have a first group
relative and a second group relative—that's where
we're thinking about how does the family history
add up. What is your relationship to other members
in your family with pancreatic cancer? Then
some people will get a gene test done. Often
a relative in their family has informed them
that they carry a BRCA gene or some similar
gene and they get tested and then those risks
are not by any means determinative but those gene
mutations carry a higher risk. Those are
the kind of people we enroll. We hope one
day we're knowing that, well, you smoked or you
have obesity or you have metabolic syndrome and
you don't have the family history but your
overall risk is at— we're still trying to
understand risk and quantify it better so we can
tailor screening for who needs it. At the moment
we kind of do okay but we really don't have—it's
very hard to predict risk as you can imagine
for future cancers, but what we rely on mainly
is the family history and the gene mutations.
In my personal history, in the case of
my husband who died of pancreatic cancer,
there turned out to be a connection between
kind of a pre-diabetes track and a spiking
of blood sugar. That turned out to be a huge
risk factor, but we didn't know that at the
time. We didn't know there was a connection to
pancreatic cancer and his primary care physician
didn't flag that there was a pancreatic cancer
connection. So, Dr. Maitra, your thoughts on that?
It frustrates me, to be honest with you, Alisyn.
I can't tell you how many talks I've given where
someone comes up to me at the end of the talk and
says exactly the story that you just said. To me,
this connection between new onset or worsening
diabetes, particularly if it is associated with
weight loss, is an incredibly important connection
that is missed by our primary care physicians,
and we've worked hard—PanCAN and Let’s Win and
others have worked hard—to really spread this
message out in both the lay community as well as
to the physicians' community. It is shocking to me
how many physicians don't know this link: that new
onset diabetes in the elderly for the first time,
especially if it's accompanied by weight loss or
the weight loss doesn't lead to improvement in
the sugar levels, the diabetes levels are
potentially—not always, but potentially—a
warning signal that there might be an occult or
silent pancreas cancer. We have looked into this,
we have done studies, and we have shown that in
individuals older than 50, plus 55 years or so,
there is a 7- to 8-fold higher risk of carrying
a pancreas cancer if you present with new onset
diabetes for the first time at that age group.
Again, because the absolute risk for pancreas
cancer, thank heavens, is still small. Even a
7- to 8-fold risk is not very large in numbers,
but it is still much larger and it's
certainly something that would warrant
doing an additional blood test or, if you were
really concerned, some sort of an imaging study,
but it keeps getting missed. I want to also
emphasize one thing. We're talking here about,
again, the unfortunate scenario that happened in
your personal story, which is new onset diabetes.
There is a risk factor that longstanding diabetes
also contributes to pancreas cancer—diabetes
longer than 15-20 years—but that's a very small
risk, just a little bit more than baseline. Here
we're talking about something that is caused by
the cancer. So when we use the word risk in the
context of new onset diabetes, we're not saying
that diabetes is causing the cancer here. This is
different from that longstanding diabetes. What we
are saying is the cancer is causing the diabetes.
Diabetes is a sign, just like jaundice or weight
loss, except it happens much earlier and therefore
you have a window of opportunity to catch this
cancer early if only action is taken. And so,
information is key. One thing that I'm hoping
podcasts like this will do is get more of that
message out there. If you have somebody in their
50s show up for the first time and their diabetes
is not responding to the usual advice, lose
weight, eat better, take this medication—at least
think, could this be something else? And you'll
be shocked how many times that doesn't happen.
I totally agree with you, Dr. Maitra,
that that is the message that we need
to get out. I think about the different
trajectory my family history would be
on right now if a primary care physician
had known of that connection. Dr. Goggins,
it does seem like you're going to need buy-in
from all of the primary care physicians and
others to know about this in order to
flag it and get screened and tested.
Yeah. The study that Anirban has been involved
with and PanCAN—it's a very important study to
help highlight and to see if intervention
could help, because the challenge is,
of course, there's so much diabetes in the
community and there's a primary care physician,
it may be only one in every hundred or
two hundred people who has new onset
diabetes. When there's something else going
on besides new onset diabetes—in other words,
is there some weight loss?—what we really need
are simple tests that help the primary care doc:
another blood test that says, "All right, let
everyone with new onset diabetes have a test that
says, well, this one's a little different;
this is not your usual new onset diabetes;
this is a concerning new onset diabetes," and
then we can get you a scan. But you're right,
at the moment that message is not out
there with the primary care physician.
We're going to talk about those kinds of tests in
one of our next episodes. Dr. Goggins, what about
the children of somebody? Obviously,
I ask for my own personal interest,
but I know a lot of other parents who
think this. If you're the child of somebody
who had pancreatic cancer, how concerned
should you be and should you be screened?
You have to take it into context. Unlike
breast cancer, for example, or lung cancer,
pancreatic cancer is thankfully not a common
cancer compared to those, although its incidence
is going up. If we estimate that the lifetime risk
of pancreatic cancer is less than 2% in your life,
even having a family member with pancreatic
cancer, hopefully an immediate blood relative—a
parent—your lifetime risk is probably close to
5%. If someone has a gene test done, that risk
can change if they have more than one relative in
the family who's a blood relative, that risk can
increase. So we're certainly wanting to be able to
intervene and offer something for people who have
an immediate family member. Pancreatic cancer,
although its incidence has risen a little bit in
younger people, is really a disease of middle-aged
and older people. It's not common at all in people
under 50. Our surveillance programs are mainly for
people aged 50 and older and with the risk going
up even for people in their 80s who can be getting
pancreatic cancer. So that lifetime risk is over
a long period of time. If you're a young person
and you've been devastated by having a parent die
of pancreatic cancer, you're still a young person.
For certain cancers, if that happened—like a young
onset breast cancer—you have to get screened
early at a young age. For pancreas cancer,
the value of doing that is really not there until
you're middle-aged in general. Maybe there's a
young onset cancer or a gene test that suggests
in a rare instance we should start surveillance
early. So yes, there is a risk there, but
it has to be put into proportion. The vast
majority of people who have a family history of
pancreatic cancer aren't going to get the disease.
And coming back to that earlier
question you asked me, Alisyn,
about which of the categories you can place more
emphasis on—this is why I mentioned hereditary.
It's a small slice, but it's the one that you
can really do something about because if the
person who was the proband—the person who's first
diagnosed with the disease in the family—happens
to have a mutation that you can test for now
for $250, you can test for a large number of
these mutations and you don't even have to
give blood for it. You can spit into a tube,
send it to a company, they'll send
you back the results. This is 2025,
we can do this very easily now. If the
unaffected family member, like a child,
now has that, then you should definitely speak
to a genetic counselor or a gastroenterologist
like Dr. Goggins and see if you merit getting on
a surveillance program. So it's a small slice,
but that slice is something where information
truly gives you the power to do something about.
Last, doctors—maybe you can just wrap it up in
a neat bow for all of us. What can people do
now to reduce their risk, especially if they have
one of the risk factors that we've talked about?
One, don't smoke, please. That's general
advice. If you can avoid it—it's not just
pancreas. Many cancers in the body are impacted by
smoking. If you have a family history, for sure,
do not smoke. I've personally given
up alcohol as of a year and a half ago
for health reasons. You don't have to
give it up, but in moderation. Again,
it is one of the obesity-associated cancers, so
it's good to have reasonable weight and exercise
and all those good things. I can't emphasize
this enough—information is power. If you have
a family history or a first-degree relative,
it's okay to know it. Do you carry a gene?
You can do that now fairly easily, and if that
is the case, talk to someone like Dr. Goggins.
I would add that all the lifestyle—you need
to lead a healthy, mentally healthy life
to prevent many cancers and diseases. But we still
screen people for breast cancer, colon cancer,
and a variety of other screenings even though we
of course recommend living a healthy lifestyle.
The main thing is identifying whether or
not you would fit into, or be eligible for,
pancreatic surveillance. Currently, that's getting
scans and things. There's a lot of work going
on—could we one day have blood tests, or one day
make the screening more available to more people,
rather than just the narrower subset where the
risk is on the higher side? See if you're eligible
for screening. Figure out your family history.
It's not easy to figure out your family history
sometimes—a lot of times it's uninformative. If
you have an immediate family member who's had
pancreatic cancer, maybe they or you could get
gene tested to better understand what your risk
is. See somebody so you understand these things
with your own doctor, your own gastroenterologist,
or a genetic counselor—someone
who can give you good information.
Well, our doctors have set us up
perfectly for our next episode,
which is about those very things: screening
and testing and their limitations. Gentlemen,
thank you both so much for sharing your expertise
with us. Really great to talk to you, and we will
be talking to you again about the next phase of
all of this. Thank you. Thank you. Thank you.
Hi everyone. I'm Cindy Gavin, CEO and
co-founder of Let's Win Pancreatic Cancer.
I want to thank Alisyn Camerota
for being our host on this episode,
and Drs. Maitra and Goggins for participating
in this important initiative. We hope you will
visit PanCAN and Let’s Win to learn more from our
resources. PanCAN can be found at www.pancan.org,
and Let’s Win is at www.letswinpc.org. We hope
you will tune in to our next episode, where we
will continue the conversation and look at the
current state of screening for pancreatic cancer.