Chicago, IL || September 2016 - - In 1966, only three years after the mammogram first became accepted within the American medical community, Dr. Philip Strax, a general practitioner with a small family practice in Manhattan, published a major study with the Health Insurance Plan of Greater New York on the technique’s effectiveness. His work would become a milestone when he concluded definitively that the early detection of breast cancer substantially reduced its mortality rate. From 1970 to 2010, as mammogram use exploded, the American Cancer Society reports the mortality rate of breast cancer in the U.S. declined by 34%, while incident rates remained largely unchanged, further supporting Dr. Strax’s findings.
Around the same time as Dr. Strax was conducting his study, Drs. William Wolff and Hiromi Shinya began developing the colonoscopy at Beth Israel Medical Center in Manhattan. In 1969, their design for both their instrument and their procedure was described, by Dr. Francis Moor, a noted pioneer in surgery, as “a quantum advance in abdominal surgery.” From 1975 to 2008, the five-year survival rate for colon cancer (all stages) jumped from 48% to 68%. Today, when it is found in its first (earliest) stage, the five-year survival rate for colon cancer is 90%.
Dr. Ralph Hruban, MD, is the Director of the Sol Goldman Pancreatic Cancer Research Center at Johns Hopkins Medicine, as well as a Professor of Pathology. He is a Rolfe Foundation grantee, and a leading expert on early detection pancreatic cancer research. When discussing survival rates for colon cancer before and after the advent of the colonoscopy, he refers you to, “these beautiful graphs! They show the face of the disease before and after this test was invented. They’re wonderful. And they beautifully illustrate impact.”
He can also refer you to graphs depicting pancreatic cancer survival rates. Though he notes, “those ones aren’t so beautiful.”
Yet the history of early detection developments within other types of cancer is cause for hope, says Dr. Hruban. “The before and after is marked,” he says. “And even within pancreatic cancer as it stands now, a patient faces a very different scenario when discovering a tumor very early, as opposed to very late.” (The five-year survival rate for pancreatic cancer discovered and treated during stage I is 29%, vs. just under 3% for stage III and above).
“The issue” says Dr. Kevin Roggin, MD of the University of Chicago, “remains awareness. Pancreatic cancer is something of an orphan disease. It’s forgotten. And even though it's a leading killer, percentage wise, it’s not seen as impacting a lot of people as far as raw numbers are concerned.”
"Pancreatic cancer is something of an orphan disease. It’s forgotten. And even though is a leading killer, percentage wise, it’s not seen as impacting a lot of people" - Dr. Kevin Roggin, MD University of Chicago
Consider, Dr. Roggin suggests, the difference in awareness between breast cancer and pancreatic cancer. Every October football fans across America watch as every squad in the NFL dons pink cleats, gloves, and Under Armour in honor of Breast Cancer Awareness Month. The league sells special Pink Gear for the month, donates a percentage of sales to breast cancer initiatives within the American Cancer Society, and creates PSAs about mammograms, screening, and hope. It’s a spectacle that has grown so large, that every year numerous think pieces crop up semi-denouncing it.
“Where would pancreatic cancer be right now if it shared this same level of attention?” asks Dr. Roggins.
Of course no side-by-side comparison of cancers is ever perfect. Both breast cancer and colon cancer, for instance, can be detected through relatively direct means. The pancreas, securely hidden deep in the abdomen, is not so readily examinable.
“It’s a different challenge,” concedes Dr. Roggin. “But progress is being made. Right now we’re working to understand more and more about the genetic changes that stimulate how cancer forms in the pancreas. It’s all part of a building process. Increased understanding of genetics and genetic changes will help us understand pancreatic cancer well enough to eventually, hopefully, be able to discover a marker for it in a person’s blood.”
And medical history should act as encouragement. After all, breast cancer was also once an underpublicized affliction. In the 1930s the breast was often too sexualized and taboo to be discussed as a topic of health. As Dr. Hruban says, “advancements build off advancements.” The mammogram, he points out, wasn’t just one discovery, but a series of developments. So too was the colonoscopy (the process was refined heavily through the first ten years of its existence).
Growth in the size of the field itself should also be encouraging. “When we first started our work, as a Foundation,” Rolfe Foundation Executive Director Lynda Robbins notes, “there were only a handful of researchers dedicated to pancreatic cancer. Today, there are more than 1,000.” That larger community, as she points out, creates an environment in which the cumulative innovations Dr. Hruban discusses may be made possible. “More research means more opportunity for breakthroughs.”
“Eventually,” insists Dr. Roggin, “over time, with enough light shined on this topic, and enough people working on it in the room – we’ll get there.”
Published: September 13, 2016
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This article also appears as part of the Rolfe Pancreatic Cancer Foundation’s
electronic newsletter, The Catalyst (Vol. 3, September 2016 – The Next Generation issue).
To read more dispatches from The Catalyst, please click the links below.