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A 2021 study of stored blood from a US screening trial showing that CA 19-9 starts rising about two years before pancreatic cancer is diagnosed and catches half of early-stage cases in the final six months, so it can anchor a multi-marker early detection test.
Fahrmann and colleagues measured CA 19-9 in blinded sera from 175 subjects collected up to five years before a pancreatic cancer diagnosis and 875 matched controls from the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial, and in independent sets of 129 resectable cases and 275 controls (100 healthy, 50 chronic pancreatitis, 125 non-cancerous cysts). Levels rose exponentially from two years before diagnosis; sensitivity reached 60 percent at 99 percent specificity within 0 to 6 months of diagnosis for all cases and 50 percent for early-stage cases. Resectable cases were distinguished from healthy controls at 64 percent sensitivity, from chronic pancreatitis at 46 percent and from cysts at 30 percent, all at 99 percent specificity. Adding LRG1 and TIMP1 raised sensitivity by 13.2 percentage points (P = 0.031) for cases below the CA 19-9 cutoff diagnosed within a year.
Fixes the window in which a blood test could plausibly work and shows why CA 19-9 alone is not enough: half of early cases are missed even at diagnosis, and Lewis-negative patients are missed entirely.
A scoring tool that needs no new test and can run in primary care records; it turns the 1 percent of Chari's cohort into a 3.6 percent group in whom imaging or a blood test becomes defensible.
The reason a normal CA 19-9 never rules pancreatic cancer out, why Lewis-negative patients need a different marker (CA 125, CEA or CA 19-9-independent panels), and a constraint on every blood-based detection idea on this page.
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Shares The hardest cancers are found late, Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question, Pancreatic ductal adenocarcinoma and the tag pancreatic-evidence.
Shares The hardest cancers are found late, Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question, Pancreatic ductal adenocarcinoma and the tag pancreatic-evidence.
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Shares Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question, Pancreatic ductal adenocarcinoma and the tag pancreatic-evidence.