Early detection helps Mayo Clinic find and treat pancreatic cancer at ‘curable stage’
Judy Ethen loves looking forward far more than looking back.
After surviving three bouts of cancer and losing several family members to the disease, the retired 71-year-old knows it’s important to be front and center for family activities and gatherings.
She and her husband of 47 years, Adrian, keep busy chasing after three grown sons and six grandchildren in their home state of Minnesota.
“I can’t get enough football games, soccer games, baseball games, music recitals and family times,” she says. “I refuse to be tied back. I’m very social, I prefer it that way. I find that if you dwell on yourself, it's a downer.”
The second youngest of 10 children, Judy lost her father and a brother to pancreatic cancer. Two more brothers died of cancer of the liver and esophagus. Judy was treated for thyroid cancer 20 years ago and underwent a mastectomy to treat breast cancer six years ago. In 2020, she was diagnosed with pancreatic cancer.
“I’ve had cancer scares over the years,” she says.
Life Expectancy Issues
Her latest diagnosis was the result of a Mayo Clinic effort aimed at finding and treating pancreatic cancer at an earlier, more survivable stage.
“I was told at the beginning that there are life expectancy issues,” Judy says. “They told me right up front that when they deal with pancreatic cancer, it’s advanced. They were telling me kind of groundbreaking things.”
According to the National Cancer Institute, pancreatic cancer accounts for only 3.2% of all new cancer cases, but it is the third leading cause of cancer deaths. The five-year survival rate is just 11.5%.
More than half of patients with pancreatic cancer are diagnosed at a late stage when treatment is far more challenging. That’s because patients typically don’t experience symptoms until the disease has spread to other organs. Patients who are diagnosed at an early stage have improved survival.
Physicians currently do not have a good way to screen large portions of the population for pancreatic cancer. While mammograms and colonoscopies are widely used to screen for breast and colon cancers, there isn’t a similar, age-specific, population-level test for pancreatic cancer.
“It’s not a very common cancer, but it’s very lethal, this makes screening challenging,” said Shounak Majumder, M.D., a Mayo Clinic gastroenterologist and pancreatologist.
Finding ‘Curable Stage Cancer’
In 2008, a cousin told Judy about a study being conducted by Gloria Petersen, Ph.D., a Mayo Clinic scientist and the Purvis and Roberta Tabor Professor. Judy’s cousin, Bill Schmidt, had lost both of his parents to pancreatic cancer and knew of Judy’s family history.
Through the study, Judy and Bill became patients of Mayo Clinic’s High-Risk Pancreas Clinic in Rochester.
The clinic is one way Mayo Clinic is working to find what Dr. Majumder calls “curable-stage cancer.”
A research team led by Drs. Majumder and Petersen and supported by a generous $22.1 million gift from The Centene Charitable Foundation is developing an early detection strategy, with the high-risk pancreas clinic serving as a translational research hub.
Patients who have a high risk of pancreatic cancer — because of a genetic mutation or family history of the disease — are regularly screened in hopes of detecting the cancer early.
“We really want to intercept it at a stage where we can make a meaningful impact in that patient’s journey,” Dr. Majumder says. “We find it early, we treat it aggressively, and that leads to better outcomes for the patient.”
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A multi-disciplinary approach to pancreatic cancer treatment
Mayo Clinic is leading the way in developing an early detection strategy for pancreatic cancer with the support of a generous gift of $22.1 million from The Centene Charitable Foundation.
The foundation has invested in a multidisciplinary team led by Shounak Majumder, M.D., a gastroenterologist and pancreatologist, and Gloria Petersen, Ph.D., an epidemiologist, that is dedicated to the development of low-cost, accurate tools for the early detection of pancreatic cancer.
Today, there is no screening test for pancreatic cancer in the general population, but Mayo Clinic researchers are focusing on developing early detection tools, including novel biomarkers that can accurately discover early-stage pancreatic cancer and enhanced imaging tools that use artificial intelligence to detect small tumors.
“Right now, pancreatic cancer screening is limited to high-risk individuals based on their familial and genetic risk, the standard approach includes MRI and endoscopy, it is expensive and invasive,” Dr. Majumder says. We want to challenge that and develop non-invasive, inexpensive, and accurate tests that can be broadly disseminated for effective early detection.”
Patients in the high-risk pancreas clinic also can participate in a research registry and clinical trials. Mayo Clinic’s high-risk pancreas clinic research registry follows these patients over time and is linked to a longitudinal bank of biospecimens and images, making it possible for researchers to innovate and create novel screening tools.
“It’s our opportunity to serve these high-risk patients, and it’s also advancing our research mission,” Dr. Majumder said. “Our fellows participate in the care of these patients, so we are also educating the next generation of gastroenterologists. It truly serves the three-shield mission of Mayo Clinic.”
Through the study Judy learned she carries a genetic mutation that increases her likelihood of developing pancreatic cancer.
Judy began annual screenings, including CT and MRI scans and endoscopy, at Mayo Clinic. In 2020, after more than a decade of surveillance, during a routine screening visit she was diagnosed with pancreatic cancer. She was asymptomatic and her cancer was detected at an early stage. Dr. Majumder referred her to Mark Truty, M.D., M.S.
After six months of chemotherapy and two months of radiation, Dr. Truty performed surgery in August 2021 to remove her pancreas, spleen and gallbladder. She spent three and a half weeks at St. Mary’s Hospital in Rochester before returning home to recover.
“Dr. Truty saved my life,” Judy says, “What I choose to do with the remainder of my time, I’ll have because of him.”
Patients who have had their pancreas removed often develop diabetes. Now cancer-free, Judy is learning to manage her diabetes and continues testing at Mayo Clinic every two to three months.
Judy credits her husband, Adrian, and her sons for their support through her treatment, surgery, and recovery. Additionally, none of their sons carry the genetic mutation she does.
“We are so blessed,” Judy says. "That was the best news I've ever heard in my life.”
Bill Schmidt learned he had pancreatic cancer between Christmas and New Year’s in 2010. He recognized in himself some of the symptoms his mother experienced before dying from pancreatic cancer at 49.
Doctors at Mayo Clinic performed a complex operation to remove the head of the pancreas, the first part of the small intestine, the gallbladder and the bile duct known as a Whipple procedure. Bill asked to have surgery at Mayo Clinic so any tissue removed could be donated for Dr. Petersen’s research.
Bill’s cancer had spread to the lymph nodes, so he also underwent chemotherapy and radiation in St. Cloud.
“I had less than a 5% chance of making it a year, and that was back in 2011,” Bill says. “I had one daughter who had yet to get married. I said I’m going to be here for that. She’s already had her fourth child.”
Bill, 66, also carries a genetic mutation increasing his likelihood of developing pancreatic cancer. The oldest of his three daughters also carries the mutation. The other two haven’t been tested yet.
He and Judy lean on each other, sharing stories and advice as they navigate life after pancreatic cancer. Diagnosed a decade after Bill, Judy calls him her mentor.
Bill, an avid outdoorsman, acknowledges his life has changed so much since his diagnosis – from watching wildlife move gracefully to even noticing the leaves rustling on trees.
“It just amazing me every day what I see that I normally would have never seen before. My eyes are a lot more open,” Bill says. “All I know is cancer, even if I die from it, has given me way more than it’ll ever take from me.”