Dear Dr Roach: It is my understanding that there is no early screening test for pancreatic cancer, and it is…
Dear Dr Roach: It is my understanding that there is no early screening test for pancreatic cancer, and it is usually not diagnosed until it is very advanced, that is, the high mortality rate. My late loved case was confirmed only after receiving a CT scan; Not even an MR revealed the tumors. A predominant person’s case was found early enough to be treated successfully only because she was a colon cancer survivor and a routine CT scan that was made as part of her follow-up revealed an early and treatable tumor in the pancreas. Why can CT scans not be routinely performed to check for pancreatic tumors? – S.C.
Dear S.C.: It is a very good question, and I am often asked not only about cancer of the pancreas but also of ovarian cancer. The answer is that pancreatic cancer is uncommon (1
-2 patients per 10,000 per year), and there are very few cases where cancer can be found early enough to make a difference. Any study done so far on screening for pancreatic cancer has not shown any reduction in the death rate from pancreatic cancer. Even when there is early CT, ultrasound or blood test, it is usually already too late for most. While I’m looking forward to Justice Ruth Bader Ginsburg, to whom I think you refer, she was one of the lucky few.
A reasonable follow-up may be: Although screening only saves some people, is not it worth doing? Unfortunately, there are disadvantages of screening. There are dollar costs for the test. CT scanning in particular has radiation, as if repeatedly over time can increase the risk of developing other types of cancer. More importantly, scans can show findings that appear to be cancer or other abnormalities, but on surgical biopsy does not prove to be important. This causes people to run unnecessarily. So far, the screening sensations, although they seem small, outweigh the much less chance of finding a curable cancer.
It is possible that breakthrough in treatment will lead to a new era for pancreatic cancer, where previously incurable disease can be treated successfully. If (hopefully when) it happens, screening can then be reevaluated.
I should note that this discussion applies to people without known risk factors for pancreatic cancer. Perhaps 10-15 percent of pancreatic cancer has a family component. People with a strong family history of pancreatic cancer or those who have a genetic condition predisposing to pancreatic cancer (such as BRCA2 or BRCA1) should consider entering a study or finding a center with expertise in screening high risk people for pancreatic cancer, where testing is more likely to benefit.
Dear Dr Roach: I have mandibular tori. What in the world got this started? Was there medication or something that happens, like from the dentist? I’m 92 and do not want it to get worse. I. L.
Dear I.L.: Almond is lower jaw and a torus is a benign growth. They are usually present on both sides, so they are called tori. A torus may also be present on the hard palate. They can grow slowly over time.
It is not clear where they are from, but they are more common in men and in people who paint their teeth, so they are believed to stem from stress in the leg. They are worried and do not need to be treated if they do not bother you. Sometimes they get so big that they bother eating or talking. If so, they can be treated surgically. Tori is quite common, but I have never referred a patient with a torus for surgery.
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