How to Minimize Pancreatic Cancer Risk


Obesity, Type 2 diabetes and metabolic syndrome, all of which have risen to epidemic levels in recent years, are linked to pancreatic cancer.

By Jane E. Brody


As an avid reader of obituaries, I’ve been struck by how many people these days are succumbing to pancreatic cancer, a cancer long considered rare.


And relatively speaking, it is still rare, accounting for just 3 percent of all cancers. But it is also one of the deadliest because symptoms almost never develop until the disease is advanced and incurable.

 

Although 55,440 cases, affecting 29,200 men and 26,240 women, are expected to be diagnosed this year in the United States, 44,330 people will die of it, often within months of diagnosis, making it the fourth leading cause of cancer deaths in this country (after lung, colorectal and breast cancer). Furthermore, it is on track to become the second most deadly cancer by 2030. 


At the same time, cases of pancreatic cancer are rising, even though the leading known risk factor — cigarette smoking — has been declining for decades. That fact alone has prompted researchers to seek explanations for other causes and, it is hoped, find ways, in addition to quitting smoking, to prevent it and detect it while still curable. 


In most of the approximately 6 percent of five-year survivors, pancreatic cancer is discovered early quite by accident, usually during a scan or surgery for some other reason. For example, in 2009, Ruth Bader Ginsburg, the associate justice of the Supreme Court, had part of her pancreas removed after a routine CT scan revealed a one-centimeter lesion. While that lesion was benign, a smaller tumor the surgeon found was malignant and had not yet spread beyond the pancreas.


The pancreas is a small two-part glandular organ — about 7 inches long and 1.5 inches wide — lying in the upper abdomen behind the stomach. It performs two vital functions. One part of the gland is a source of digestive enzymes and the other part produces the hormones insulin and glucagon that control blood levels of glucose and fatty acids. 


Some known risk factors for pancreatic cancer are beyond an individual’s control: older age, being an African-American or Ashkenazi Jew and having two or more first-degree relatives (parents or siblings) who have had the cancer.

 

But it is the modifiable risk factors that are currently of greatest concern. Aside from tobacco smoking, which accounts for 20 percent to 25 percent of pancreatic cancers even as this risk factor continues to decline, the main risks for pancreatic cancer cases and deaths are obesity, Type 2 diabetes and metabolic syndrome, all of which have risen to epidemic levels in recent years.

 

Data gathered in many studies “clearly show a relationship to obesity,” said Donghui Li, a molecular epidemiologist at the M.D. Anderson Cancer Center in Houston. “The higher the B.M.I., the greater the risk of pancreatic cancer,” she said in an interview. “Obesity contributes to both onset and progression of this cancer.”


Dr. Li added, “The distribution of fat also plays a role — the higher the waist to hip ratio, the greater the risk.” She found that cancer risk was greater the earlier in life a person becomes obese, and survival time was shorter among those who were still obese when the cancer was diagnosed. 


Obesity is also the leading risk factor for the development of Type 2 diabetes, in which the body resists the action of insulin, prompting the pancreas to produce more and more of this hormone. Insulin promotes cell growth, providing a link between diabetes and the development of pancreatic cancer.


However, the relationship is complicated, to say the least. In a 2011 report in Molecular Carcinogenesis, Dr. Li noted that “diabetes or impaired glucose tolerance is present in 50 to 80 percent of patients with pancreatic cancer.” She said, “Diabetes is both a cause and consequence of cancer,” although which comes first — diabetes or cancer in the organ that controls blood glucose — is not crystal clear.

A European study of more than 800,000 people with Type 2 diabetes found this disease is sometimes an early sign of an otherwise hidden pancreatic cancer. 


In studies at the Mayo Clinic, elevated glucose levels, a condition called pre-diabetes, were detected in some patients two years before pancreatic cancer was diagnosed. In these patients, Dr. Li explained, diabetes is actually a symptom of the hidden cancer. It is a type of diabetes called 3C, caused by a diseased or damaged pancreas, and medical researchers are now looking for ways for doctors to readily distinguish between Type 3C and Type 2 diabetes.


The lag time between the development of diabetes and diagnosis of cancer is a potential window of opportunity that may enable cancer detection at an early, curable stage, Dr. Li said.


If a biomarker for the cancer was identified, it may be possible to find cancer in these patients when the tumor is too small to be seen on a scan and before symptoms develop. For example, an antibody might be used that targets a molecule on small tumors.


Dr. Li urged doctors to be alert to the possibility of hidden cancer in patients newly diagnosed with diabetes who are 50 or older, have no family history of the disease, are losing weight and their diabetes is not controlled by oral medication.


In general, when diabetes or pre-diabetes is present for many years before pancreatic cancer is found, the blood sugar abnormality is likely to have played a role in initiating or promoting the growth of cancer. The longer patients have diabetes, the lower the cancer risk, though even after 15 years with the disease the risk of pancreatic cancer is higher than in people without diabetes.


In the less than 10 percent of people with familial pancreatic cancer, many of whom are in a national tumor registry at Johns Hopkins Medical Center, genetic testing has identified several genes associated with the cancer that could predict their cancer risk. The higher the risk, the more frequently a CT scan could be done to look for a relatively early cancer. 


Early diagnosis is vital, Dr. Li said, because pancreatic cancer is highly resistant to most therapies and often recurs after surgery. Currently, only 20 percent of cancers are even eligible for surgery, she said. The pancreas is next to very large blood vessels and when the tumor involves them, it cannot safely be removed. 


One bright spot for people with diabetes: The drug metformin, often used by patients to help control blood sugar, has in some studies been associated with a reduced risk of pancreatic cancer and improved survival chances for those who develop the cancer. This drug, which has also been linked to longevity and healthy aging, is an inexpensive generic with an excellent safety record.


 


The nature of work life in the U.S. has become much more sedentary during the last half century. Too much sitting can plunge your body into hibernation mode and grind you down. Over time, it can lead to brain fog, anxiety and depression, as well as chronic health conditions including heart disease and Type 2 diabetes. Quick bursts of exercise to disrupt sitting, at least every hour or so, can help counter-balance the effects of sitting.

Too much sitting can kill you. An app can help change that.


By Scott Scanlon


Leading wellness experts paint a bleak picture of what happens to people who sit during most of their waking hours.


The damage starts as quickly as 20 uninterrupted minutes in a chair or on a couch.


Your metabolism slows. Your blood sugar level rises. Your liver looks to mop up the excess sugar and store it as fat – across your body.


If you spend lots of time at a computer, you hunch forward and tension builds in your neck, shoulders and parts of your back.


Such lethargy – stretched over workdays, work months, careers – can lead to brain fog, anxiety and depression, weakened core muscles, and chronic pain. It contributes to heart disease, Type 2 diabetes and other serious health challenges.


"Sitting is so much more far reaching than even the adverse effects of smoking because, plain and simple, eight out of 10 people nowadays sit between 10 and 12 hours a day," Lancaster chiropractor Jeff Grazen said. "Eight out of 10 people don't smoke."


That's why Grazen – a guy who owned a flip-phone until three years ago – and two of his patients created a startup company to build a computer application designed to get users off their fannies and into short exercise routines several times a day. It caps off the routines with health tips for those who lead mostly sedentary lives – primarily at work.


In theory, the app has a large pool of potential customers. Half of American workers were employed in moderate physically active jobs in 1960, compared to 20 percent at the start of this decade, according to the health journal PLoS One.


Rates of obesity, diabetes and prediabetes have skyrocketed since.


Those involved in fitness classes or other exercise before or after work also can benefit from the app.


"Something you do at the end of the day for one hour, three evenings a week, doesn't actually offset the harm for what you do 15 hours a day, seven days a week: sit," Dr. James A. Levine told National Public Radio in 2015, a year after publication of his book, "Get Up!: Why Your Chair is Killing You and What You Can Do About It." Levine, a Mayo Clinic endocrinologist and international obesity expert, invented the treadmill desk.


Grazen points to the book, and studies on extended sitting, as he urges his patients, and now app users, to get up and move. A 1989 graduate of the National College of Chiropractic in Chicago, his office protocol includes spinal manipulation and other chiropractic adjustments, then sending patients home with a set of exercises.


"I tell them, 'You're going to learn how to control this problem yourself, and you're going to rehabilitate and not become dependent on someone else to take care of you," he said.


The idea for the Well Fit Plus app bubbled up after a female patient with a busy desk job – suffering from neck, shoulder and upper back pain – wanted a better sense of the exercises Grazen recommended she do at home.


Grazen touts the "side effects" of regular use as more energy, better metabolism and lower blood sugar and cholesterol readings. Consistent users also have lost weight, he said.


"The problem in industry today is that we all sit, so how does your wellness program address the elephant in the room? Now, I come in and talk about the bull's-eye, which is plain and simple: Get 'em up."



Adverse effects of sitting

Within 20 minutes of sitting, your body starts to shut down. “We call that the cascade to failed health,” said Jeff Grazen, co-owner of the Well Fit Plus app. This is what prolonged sitting and a sedentary lifestyle can do to you over time:


Brain fog

It can add to lack of focus, headaches, low mood, stress and anxiety, and may increase Alzheimer’s risk


Inflexible spine

Sitting in a hunched position can curve and tighten the spinal column and lead to neurological problems, including back pain. Tension also builds in the shoulders and across the neck. Numbness can radiate in your limbs.


Heart disease

Increases blood pressure, cholesterol and triglyceride levels. Over time, this raises the risk of heart attack and stroke, and may lessen the lifespan by up to a decade.


Overproductive pancreas

Being sedentary causes the overproduction and growing ineffectiveness of insulin, raising the risk of Type 2 diabetes and its related health complications.


Obesity

Men who sit most of the time are more likely to become obese. Your body will store up to 95 percent of carbohydrates as fat if you sit most of your waking hours.


Cancer

Research suggests prolonged sitting may increase the risk of breast, colon and endometrial cancer, perhaps by excess insulin boosting cell growth or because of lower production of antioxidants, which kill cell-damaging free radicals.


Limp glutes

These muscles – important in balance, including walking – are at rest while sitting.


Weak abs

These muscles are key to functional movement, including walking and balance.


Weakening hip flexor

Chronic sitters rarely extend hip muscles, which shorten and tighten them, decrease mobility and raise the risk of falling.


Varicose veins

Extended sitting slows circulation and can cause blood to pool in the legs. Swollen ankles also can result.


What you can do?


  • Exercise:
  • The surgeon general recommends 150 minutes of moderate to intense exercise each week – including walking.

  • Get up and move frequently: 
  • Research shows even if you exercise regularly or go for a long walk daily, you still will experience the adverse effects of prolonged sitting and being sedentary. “After as little as 20 minutes of sitting, the adverse effects start to effect our normal body function, metabolism and blood sugar handling,” Grazen said. “The key is frequent and regular activity breaks. Mix standing and sitting throughout your day. Flex your muscles. Ninety seconds of challenging movement every 20 minutes is optimal; 90 seconds every hour will suffice.”

  • Eat more protein: 
  • Snacking on protein can increase metabolism; eating carbohydrates can slow it down. Snack on nuts, jerky, seeds, beans, vegetables, soy nuts, string cheese, hard boiled eggs, chicken or turkey. Forego red meats.

  • Cut simple carbs: 
  • Gain an immediate impact on your health, wellness and energy levels by avoiding sweets, sugared drinks, breads, processed foods, bagged and boxed snacks.

  • Breathe: 
  • Take a deep breath, pause and let it out. Relax while you do it. This naturally reduces your heart rate and reduces stress.



Sources: Jeff Grazen and Well Fit Plus, Centers for Disease Control and Prevention, Mayo Clinic