The Future

September 5th, 2011

I am often asked, “what does the future hold in the care of patients with pancreatic cancer and for pancreatic cancer research?”. While I am no soothsayer, I thought it might be helpful for me to articulate, as best I can, some of the excitement that I feel.

Not that long ago, there was no hope.  Pancreatic surgery was a dangerous affair, with operative mortality rates approaching 20 percent.  In the research labs there were no leads. The research that was being done was mostly mundane, offering little hope for significant advances.  Then, in the last decade, in what seemed like a blink of an eye, things changed dramatically.  Where there was no hope in patient care, surgery became safe.  Where there were no leads in research, new discoveries, particularly in cancer genetics, provided many new leads.

Having witnessed the exciting discoveries made in the last few years, particularly the sequencing of the entire pancreatic cancer genome by scientists in The Sol Goldman Pancreatic Cancer Research Center here at Johns Hopkins, I am now profoundly excited about what lies ahead. Perhaps most exciting are the new opportunities to integrate research discoveries into improved patient care.  Let me give just three examples.

First, from the sequencing we have discovered rare genetic changes that can increase a person’s risk of developing pancreatic cancer (just as we inherit our eye and hair color from our parents, so to do some individuals inherit an increased risk of developing pancreatic cancer).   The discovery of genes that increase the risk of a person developing pancreatic cancer means that we can now test members of families in which there is a clustering of pancreatic cancer and, in some cases, we can determine which family members are at risk, and which are not.  Those at risk may which to participate in research trials of screening for early pancreatic cancer, while those not at increased risk would be relieved of their anxiety.

Second, from the sequencing we have learned that it takes years, if not decades for a pancreatic cancer to develop. This exciting discovery means that there likely is a large window of opportunity to detect and treat curable precancerous lesions in the pancreas before patients develop incurable advanced disease. Just as colonoscopy can be used to detect and treat colon polyps before a colon cancer develops, so too do we foresee a future in which the early detection of curable pancreatic tumors will save many lives.

Third, from the sequencing we have discovered genetic changes, mutations in specific genes, that characterize precancerous cysts in the pancreas.  Cysts (small fluid-filled sacs) are fairly common.  The problem has been that doctors haven’t been able to determine which cysts are potentially harmful (precancerous) and which are harmless. Now, with this advance, there is hope that doctors will be able to tell when a cyst needs to be removed and when it is safe to leave it in place.

These are but just a few of the many exciting discoveries made in the research lab that will be applied, in the not too distant future, to patient care.  The pace of discovery is mind boggling.  As Mario Andretti said, “if everything seems under control you just aren’t driving fast enough.”

We sincerely thank all of you who have supported our research over the years.  You have made a profound difference.

Dr. Hruban