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The BRCA1 and BRCA2 genes are typically linked with raising the risk of breast cancer, but they can also increase the risk of pancreatic cancer. Identifying mutations in these genes through genetic testing allows clinicians to guide patients toward targeted screening, prevention and personalized treatment plans. That's why it’s so important to understand your family's health history – all the way down to the DNA.
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Precision medicine allows your doctor to tailor treatment plans based on your genetic makeup, leading to more targeted care and better outcomes.
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The recent death of 51-year-old R&B singer D’Angelo from pancreatic cancer has put a new spotlight on the disease.
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A medical oncologist at Swedish explains the link between genetics and pancreatic cancer and discusses the importance of genetic testing in guiding personalized treatment and helping families understand their own potential risks.
Our bodies perform microscopic miracles every day, whether it’s dividing cells, copying DNA or doing any of the other countless tasks required to sustain life. When proceeding as it should, the process happens billions of times a day without us ever noticing. But even the most efficient systems in biology can make mistakes, and when they do, the results can be serious, and sometimes life-changing health consequences.
“Your body makes errors every day, even every hour. When cells divide, they have to copy genetic information so new cells look identical to the old ones,” says Ronan Hsieh, M.D., medical oncologist at Swedish Cancer Institute First Hill.
“Humans have about 25,000 functional genes, each with millions of codes. Unlike a computer’s simple copy-paste, our bodies use proteins to replicate each gene millions of times daily across countless cells. It’s actually amazing how well this system works,” he adds.
Even the healthiest cells can make mistakes. If enough abnormalities occur, they can accumulate over time and cause serious health issues. In a small percentage of people, inherited changes in specific genes can make these errors more likely to occur.
What is familial or inherited cancer?
Some families carry specific gene mutations that make them more likely to develop certain cancers.
“If a parent passes down a defective repair mechanism, such as BRCA1 or BRCA2, your body starts at a disadvantage. The BRCA1 and BRCA2 genes are most often associated with breast cancer. However, they can also increase the risk of pancreatic cancer,” says Dr. Hsieh. “The body’s built-in repair systems normally catch and fix tiny genetic errors. But when repair mechanisms break down or when someone is born with a defective repair gene, those changes can accumulate and lead to cancer later in life,” he explains.
How do genetics change treatment options?
Knowing your genetic makeup helps guide your doctor’s treatment choices. The more details your care team has about your physical makeup, the better they can tailor your care plan to your unique needs. This approach, known as precision medicine, is improving treatment options for serious illnesses like pancreatic cancer.
“If a patient carries BRCA1 or BRCA2, their cancer tends to respond better to platinum-based chemotherapy rather than gemcitabine,” says Dr. Hsieh. “Knowing that helps us choose the most effective therapy.”
Doctors may also test for other, less common mutations such as gene types KRAS, NRAS and NTRK, which can sometimes be treated with targeted therapies.
Genetic testing
Genetic testing can provide vital information to help you better understand your potential health risks. It gives your doctor important information to guide their recommendations and inform your care. Early identification of genetic issues can prompt you to take preventive action sooner to achieve the best result possible.
Testing usually involves both blood and tissue samples. There are two kinds of tests:
- Somatic testing uses tissue samples to look for mutations found in the cancer itself.
- Germline testing uses blood to look for mutations passed from parent to child.
“All pancreatic cancer patients should have genetic testing,” says Dr. Hsieh. “If they test positive for a mutation, their first-degree relatives – parents, siblings and children – should be tested as well. The more genetic detail you know, the more personalized the treatment can be.”
When is screening appropriate?
For people who test positive for a genetic mutation, there’s no easy answer when it comes to screening for pancreatic cancer, which has come back into focus with the recent death of R&B singer D’Angelo. Just 51 at the time of his death, the neo-soul star was hospitalized for months before his passing in hospice care, according to family members.
“Even with a genetic mutation, there’s only about a 40 to 50% chance you’ll develop pancreatic cancer,” says Dr. Hsieh. “Screening is difficult and invasive. Imaging involves radiation and can involve false positives. Scopes are even more invasive. Screening decisions should always be made with a genetic counselor or specialist who can help you weigh the potential benefits and limitations.”
New and promising treatments
Several new treatment options are showing promising results in the fight against pancreatic cancer.
“There are new targeted inhibitors for KRAS mutations showing strong early results. In phase-one studies, these KRAS inhibitors shrank tumors in about 60% of cases, compared to about 40% with standard chemotherapy. That’s huge progress,” says Dr. Hsieh.
“Here at Swedish, we’re involved in a trial called Pan-RAS, which targets RAS [gene] mutations across multiple cancers,” he adds. “It’s still early, but it looks promising. Demand is high, so there’s a waitlist, but we’re hopeful about the results.”
Learn more and find a physician or advanced practice clinician (APC)
If you have a family history of cancer or want to better understand your genetic risks, genetic testing could be the first step toward protecting your health.
Whether you require an in-person visit or want to consult a doctor virtually, you have options. Contact Providence Swedish Primary Care to schedule an appointment with a primary care physician. You can also connect virtually with your doctor to review your symptoms, provide instruction and follow up as needed.
And with Providence Swedish ExpressCare Virtual, you can receive treatment in minutes for common conditions such as colds, flu, urinary tract infections and more. You can use our provider directory to find a specialist or primary care physician near you.
Information for patients and visitors
Additional resources
The future of cancer care is in your genes
Swedish Cancer Institute earns National Pancreas Foundation Center designation
AACR Project GENIE: Making a worldwide impact in cancer research and precision medicine
This information is not intended as a substitute for professional medical care. Always follow your health care professional’s instructions.
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