When it comes to deadly diseases, pancreatic cancer is not all that common. There are roughly 53,000 new cases annually – barely 3% of all diagnosed cancers. Yet pancreatic cancer accounts for 7% of all cancer deaths. The vast majority of people afflicted – over 90% — don’t survive.
Why is pancreatic cancer so dangerous – and so lethal?
A major part of the problem is that pancreatic cancer doesn’t obviously present itself as cancer – at least not early enough to be treated successfully.
Abdominal or mid-back pain, loss of appetite, jaundice, nausea, weight loss, a change in stool or recent-onset diabetes are all possible symptoms of pancreatic cancer. However, most patients – and many doctors — treat these symptoms without considering their potential for greater morbidity.
In fact, there may be another reason pancreatic cancer doesn’t get the attention it deserves: Alcohol.
Recent studies have linked heavy drinking to a higher risk for pancreatic cancer. For example, a study conducted in 2011 compared people that consumed on average three drinks of liquor daily to those that drank more modestly. The heavy drinking group was about a third more likely to develop pancreatic cancer, the study found.
This was no mere snapshot view. Researchers tracked the drinking habits of 1.2 million Americans over a period of 24 years. Moreover, even when researchers controlled for other possible cancer risks, including obesity, age, diabetes and a history of smoking, a close statistical association between alcohol use and pancreatic cancer was confirmed.
Admittedly, correlation is not necessarily causality. Heavy alcohol use has also been associated with several other cancers – including breast, colon and liver cancer. And it remains unclear what level of alcohol use is potentially cancer-causing.
Some studies have suggested that moderate drinking can actually reduce the risk of cardiovascular disease in middle-aged adults. But it turns out that most of these studies have been funded by the alcohol industry, which has a vested interest in downplaying the health risks of drinking.
The link between alcohol and pancreatic cancer may be hard to prove conclusively, but researchers agree that heavy alcohol use is a major risk factor for pancreatitis, which is often a prelude to pancreatic cancer. Pancreatitis – a condition that can be acute, lasting just a few hours or chronic, lasting years — features sharp upper abdominal pain, fever, vomiting and nausea.
Research shows that a single drinking “bender” can lead to a bout of acute pancreatitis. Binge drinkers can develop the chronic version of the disease, which weakens the pancreas to the point where it stops producing the enzymes needed to digest food. Severe weight loss and other life complications may result.
Chronic pancreatitis has no cure. There are a host of medical interventions available – including surgery, prescription pain killers and enzyme replacement drugs. However, one in five people with a pancreatitis will die within five years of being diagnosed.
The public health threat of pancreatic cancer is clearly growing. In 2014, it was the fourth-leading cause of cancer deaths in the U.S. Today it is number three. At current rates, it will soon overtake colon cancer for the number-two spot, right behind lung cancer.
In the final analysis, high mortality rates for pancreatitis and pancreatic cancer reflect a culture soaked in alcohol – and often in denial about its scope and consequences.
Some studies still blame smoking for pancreatic cancer and barely mention alcohol – which only shows how deep the institutional denial remains.
In fact, smoking prevalence rates have dropped sharply over the past two decades, especially in recent years. But alcohol use has not. The increase in heavy drinking, including binge drinking, has been especially pronounced.
For example, heavy drinking increased 30% between 2002 and 2012, after a period of decline, according to a 2018 study. The drinking increase was especially sharp for African-Americans and seniors, two groups that are also at the highest risk for pancreatic cancer.
What’s the solution? Reducing alcohol use, especially binge drinking, would surely help.
The American Cancer Society recommends that women should limit their alcohol use to no more than one drink per day, and for men, to no more than two drinks per day.
In addition, for people with a family history of pancreatic cancer, or suffering from chronic pancreatitis, some new medical imaging, and endoscopic techniques are available to detect precancerous lesions or early pancreatic cancer that can be surgically removed.
But so far, none of these new techniques has been shown to reduce the number of pancreatic cancer deaths.
With ever-increasing alcohol use, and continuing denial, stopping this silent killer won’t get any easier.