Dear Dr. Roach • It is my understanding that there is no early screening test for pancreatic cancer, and it…
Dear Dr. Roach • It is my understanding that there is no early screening test for pancreatic cancer, and it is typically not diagnosed until it is very advanced, hence the high mortality rate. My late loved one’s case was confirmed only after having a CT scan; not even an MRI revealed the tumors. A prominent person’s case was found early enough to be successfully treated only because she was a colon cancer survivor and a routine CT scan that was done as part of her follow-up revealed an early and treatable tumor in her pancreas. Why can CT scans not be routinely checked to check for pancreatic tumors? ̵
Answer • It is a very good question, and one I am often asked, not only about cancer of the pancreas but also about ovarian cancer. Pancreatic cancer is uncommon (one to two people per 10,000 per year), and there are very few cases where the cancer can be found early enough to make a difference.
Every study done so far on screening for pancreatic cancer has shown no reduction in the rate of death from pancreatic cancer. Even wanneer gevonden vroeg bij CT, ultrasound of bloed testen, is het gewoonlijk al te laat voor de meeste. While I’m praying for Justice, Ruth Bader Ginsburg, she was one of the lucky few.
A reasonable follow-up might be: Even if screening only saves a few people, is not it worth doing? Sorry, there are downsides to screening. There are dollar costs of the tests. CT-scans in het bijzonder hebben straling, die als herhaaldelijk, over de tijd kan de risico’s van het ontwikkelen van andere soorten of kancers. More importantly, scans can show findings that appear to be cancer or other abnormality, but on chronic biopsy turn out to be nothing important. Dit veroorzaakt mensen om te worden bediend onnodig. So far, the harms of screening, even though they seem small, outweigh the much smaller chance of finding a curable cancer.
It is possible that breakthroughs in treatment will lead to a new era for pancreatic cancer, where formerly incurable disease can be successfully treated. If (hopefully when) that happens, screening then may be re-evaluated.
I should note that this discussion applies to people with no known risk factors for pancreatic cancer. Perhaps 10 to 15 percent of pancreatic cancer has a familial component. People with a strong family history of pancreatic cancer or those with a genetic condition that predisposes to pancreatic cancer (such as BRCA2 or BRCA1) should consider enrolling in a study or finding a center with expertise in screening high-risk people for pancreatic cancer, where testing is more likely to have benefit.
Dear Dr. Roach • I have mandibular tori. What in the world got this started? Was it medication or something catching, like from the dentist? I am 92 and do not want it to get worse. – I.L.
Answer • The mandible is the lower jaw, and a torus is a bone growth. They are usually present on both sides, so they are called tori. A torus can also be present on the hard palate. They may grow slowly over time.
It’s not clear where they come from, but they are more common in men and in people who grind their teeth, so they are thought to arise from stress in the bone . De er eller ingen bekymring og behøver ikke behandles med mindre de er bothering you. Occasionally they get so big that they interfere with eating or speech. Hvis det er tilfældet, kan de behandles surgically. Tori is quite common, but I have never referred a patient with a torus for surgery.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]