Screening tests for pancreatic cancer: searching for the early symptoms or the population at risk.

In the past four decades, the incidence of pancreatic cancer has increased steadily in most of the world and now this type of tumor ranks as the fifth or sixth most frequent cause of death due to cancer in many western countries [1]. For example, in 2000, worldwide figures for pancreatic cancer were projected at 216,400 new cases and 213,500 deaths [2]; the data coming from the United States in 2004, estimated that 31,860 patients would be diagnosed with pancreatic cancer and 31,270 would die of the disease [3]. The 5-year survival rate estimated by the Surveillance Epidemiology and End Results program is 4% and this figure is the lowest for all types of cancer [4]. Late diagnosis and the subsequently low resection rate is the major reason for the poor survival of these patients. Despite technological advances, the diagnosis of pancreatic cancer continues to be made very late and the prognosis remains extremely poor. This delay in diagnosis is, for the most part, due to the fact that abdominal pain and jaundice, which are the main symptoms of pancreatic cancer, appear late when the tumor is already in an advanced stage [5]. Moreover, if we consider that the many epidemiological studies performed so far have failed to identify significant risk factors for pancreatic cancer which might facilitate its early diagnosis or prevention [6], the resulting picture is extremely poor. At present, the only source of hope of reaching a more rapid diagnosis of this type of cancer would seem to come from the clinical history and, in particular, from the presence of earlier symptoms which could induce patients to seek medical advice at a time when the tumor might be smaller and treatment more feasible. Surprisingly, despite the large number of studies on pancreatic cancer, very little is known on this topic. Early studies reported the existence of early symptoms such as sudden onset of diabetes mellitus, weight loss tiredness and malaise, change in bowel habits, and upper abdominal discomfort of pancreatic cancer; however, either the time of onset [7] or the symptoms themselves [8] were not specified. Three years ago, a study carried-out in Italy involving a large series of patients with pancreatic cancer was published. Its objective was to investigate whether symptoms exist before the pain and/or jaundice that could suggest the possibility of pancreatic cancer and thus help earlier recognition of the tumor [9]. The authors …