Pancreatic Cancer Research: the Epidemiological Approach

by Columbia Surgery on November 9, 2012

What makes a medical center great? In addition to some of the obvious requirements such as the expertise of its physicians and surgeons, one vital factor is the center’s active leadership in research and the application of that research to patient care. At the Pancreas Center, that kind of leadership is evident in many ways: its innovative program for early detection and prevention, its unique program to monitor patients with pancreatic cysts, and its numerous research studies on all aspects of pancreatic cancer.

Jeanine Genkinger, PhD

Jeanine Genkinger, PhD

Today’s interview highlights Jeanine Genkinger, PhD, an epidemiologist at NYP/Columbia’s Mailman School of Public Health who focuses a significant portion of her time studying the causes of pancreatic cancer. Dr. Genkinger received her Masters degree in Health Sciences and her PhD in epidemiology from Johns Hopkins Bloomberg School of Public Health. She then did a joint post-doctoral fellowship in nutrition at Harvard University School of Public Health and at the Karolinska Institutet, Stockholm. Dr. Genkinger was an Assistant Professor at Georgetown University Medical Center before accepting her position at NYP/Columbia in 2009.

Q: Why have you chosen to work in the field of pancreatic cancer?

Dr. Genkinger: My work overall focuses on the study of rare cancers, one of which is pancreatic cancer. I came to NYP/Columbia in large part because of the outstanding work underway at the Pancreas Center, and because I hoped to make an impact on pancreatic cancer through my research.

Q: Research indicates that the incidence of pancreatic cancer is rising at an alarming rate. By 2015, it is expected that pancreatic cancer will rise from being the 4th most deadly form of cancer to the 2nd most deadly. Can you explain this dramatic increase?

Dr. Genkinger: Trends have indicated an increase in the incidence of pancreatic cancer, and there may be several reasons for this increase. First, in our steadily aging population, the incidence of cancers will increase proportionately on the whole. However, other cancers such as breast cancer, prostate cancer, and colorectal cancer are typically detected at earlier stages and have better prognoses than pancreatic cancer. Therefore even though there may be higher numbers of people who develop other types of cancer, other forms are more treatable and less deadly. Another important factor is that certain risk factors for pancreatic cancer – namely obesity and type 2 diabetes – continue to rise.

Q: How do epidemiologists go about studying a disease as challenging as pancreatic cancer?

Dr. Genkinger: Examining the causes of pancreatic or other rare cancers is best done by combining data from many prospective studies, which follow large groups of patients over time. Prospective studies allow us to examine whether exposures reported long before diagnosis are associated with a higher or lower risk of pancreatic cancer.

Q: What have prospective studies been able to reveal about pancreatic cancer so far?

Dr. Genkinger: I have been involved with one such effort, called the Pooling Project of Prospective Studies of Diet and Cancer, an international consortium which combined data from a number of epidemiological studies. This research has been funded by the National Cancer Institute to try to identify associations between lifestyle factors, dietary factors and obesity and cancer risk. Through this project, I have recently examined the following factors: alcohol intake, obesity, sugar-sweetened beverages and dairy products. In our study of 14 prospective cohort studies, we observed a higher risk of pancreatic cancer for higher intakes of alcohol and sugar-sweetened beverages compared to lower intakes. We also observed a higher risk of pancreatic cancer for those individuals who are overweight and obese compared to normal weight individuals.

Q: Can you tell us about the PREDICT registry at the Pancreas Center?

Dr. Genkinger: The PREDICT Registry is a prospective registry of patients who have pancreatic adenocarcinoma or other related conditions, such as pancreatic cysts, and people who are at high risk for pancreatic adenocarcinoma. In this voluntary protocol, we ask patients to donate blood and urine samples, and to complete a questionnaire about their health and lifestyle factors, such as their diet and physical activity level. The goal of this registry is to collect data that may help us better understand which factors are associated with an increased risk of developing pancreatic cancer. This data will be extremely valuable for researchers studying pancreatic cancer.

Q: How will this data be used?

Dr. Genkinger: Having a questionnaire data that includes health information as well as biospecimens (blood, urine) will enable researchers to conduct many studies in an attempt to identify factors that contribute to pancreatic cancer. Markers that are detectable in the blood or urine, combined with complete information on a patient’s health history available with each specimen, may also help us to identify factors that predict risk in those without disease.

There are few risk factors for pancreatic cancers, but through other prior research, we have learned that smoking, obesity, alcohol abuse, diabetes, and sugar-sweetened drinks are associated with an increased risk of pancreatic cancer. In addition to searching for lifestyle factors such as these, we are also analyzing markers in blood and tissue called epigenetic factors, to try to detect whether they may be associated with pancreatic cancer development, progression and treatment response. For example, by analyzing measures in blood and tumor tissue before and after treatment, we can determine if the presence of certain epigenetic factors may be associated with better or worse response to certain therapies. We hope to identify who might respond better to which therapies based on such factors. This kind of research may also prove useful in helping to identify other epigenetic and genetic factors involved in pancreatic cancer.

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