Detection of Patients at Increased Risk of Pancreatic Cancer Utilizing Electronic Databases

Abstract

Purpose: Pancreatic cancer is the four and fifth most common cancer in men and women respectively and has the lowest five-year survival rate of any cancer. Surgical resection offers the only hope for cure; however 52% of patients have stage IV disease at the time of diagnosis. The current problem is there are no means to identify patients who are at risk of developing pancreatic cancer at an early resectable stage. We hypothesize that there may be certain risk factors which predispose patients for pancreatic cancer. If a combination of these factors could be determined then screening exams could be offered to these patients with endoscopic ultrasonography. Methods: A retrospective review of our tumor registry was used to identify 638 patients with pancreatic cancer diagnosed between the years of 1995–2005. Patients that were referred from an outside institution or not routinely followed at Scott & White were excluded. The remaining 397 patients had their electronic medical records reviewed to determine if the incidence of certain factors or combination of factors portend a higher risk of pancreatic cancer. The factors reviewed included: the presence of an elevated amylase or lipase, new onset diabetes, chronic pancreatitis, family history of pancreatic cancer, history of unintentional weight loss, and abnormal pancreatic radiographic imaging. In addition, we also reviewed the same criteria of age/sex matched controls seen at the GI clinic during this same period. Results: Multiple factors on univariate analysis including elevated amylase and lipase, family history of pancreatic cancer, alcohol use, elevated CEA, new onset diabetes as well as use of diabetic medications are present more commonly in patients with pancreatic cancer as compared to their age/sex matched controls. Multivariate analysis revealed family history of pancreatitis, use of diabetic medications, and history of weight loss or abdominal pain were significantly increased in pancreatic cancer patients versus controls. Conclusion: Conclusions: Our results indicate a combination of the above factors are more common in patients with pancreatic cancer. Patients with these risk factors should be identified while asymptomatic and offered a screening exam, either with CT scan or endoscopic ultrasound depending on local expertise, to find potentially resectable pancreatic cancers.