Does urine hold the key to a pancreatic cancer test?

CancerCells by dream designsFor a variety of reasons, including a lack of tests to detect pancreatic cancer in its early treatable forms and the poor performance of current treatments, pancreatic cancer has one of the poorest survival of all cancers – sadly, with many patients dying within months of diagnosis. Thus, the search for new tests to identify pancreatic cancer in its early stages is a top priority in cancer research.

Just this week (1), researchers from Barts Cancer Institute in London report that a signature of three proteins measured in urine samples are able to identify early, less aggressive pancreatic cancers and distinguish them from normal healthy individuals, and individuals with chronic pancreatitis, an inflammatory condition of the pancreas often confused with pancreatic cancer (and which itself increases the risk of developing pancreatic cancer) (2).

This important study is indeed exciting and suggests that we are getting closer to the day when we will be able to identify these cancers in their early stages, and treat them, saving tens of thousands of lives. However, it is important to remember that implementing a screening test in the population (or in higher risk individuals) requires many more studies on thousands of individuals to demonstrate true benefit. These types of confirmatory studies are necessary, very costly, and they take time.

Further, it is unlikely that these three urinary protein markers on their own will be enough to identify all early cases of pancreatic cancer with high accuracy. In fact, many excellent research groups (including within EPIC) are also trying to identify tests for early cancer detection using a variety of ‘non-invasive’ methods (e.g., saliva, urine, and blood).  Some of these studies have been fairly successful – why then, have we not seen these results used to help more people? One reason is that we must be sure that the test can identify all (or nearly all) cancers early – when they can be treated; and, on the flip side, that the test will also correctly identify people who do not have cancer. Doing both in one simple test is a huge challenge for researchers.

In conclusion, what is becoming clear is that many more proteins and other types of tests (genetic, epigenetic, clinical, biochemical, etc) in addition to these three urinary proteins will likely be necessary to get us to the desired goal of catching pancreatic tumours early. This new study is also important because it shows that current technology allows us to identify just three proteins out of thousands that may help to detect some pancreatic cancers early. How this test will work in the real world is not yet clear, and must be thoroughly demonstrated.

What is clear is that much more research to identify pancreatic cancer early still needs to be done, and in the meantime, research on modifiable risk factors to prevent pancreatic cancer from developing in the first place (primary prevention) should continue unabatedly.

 

(1) BBC News: Pancreatic cancer urine test hope, 3rd August 2015

(2) Radon TP et al. Clin Cancer Res 21(15), 1st August 2015

Eric Duell

Eric Duell

Eric Duell is an epidemiologist from the USA – he has lived in Europe since 2007 when he began collaborating with investigators from the EPIC cohort. He lives and works in Barcelona, Spain, the coordinating centre for the Spanish component of the EPIC cohort.

Research Interests: Pancreatic cancer, gastric cancer, nutritional/environmental epidemiology, molecular/genetic epidemiology
Eric Duell

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