By Carl Zebrowski
Editor

 

Dr. Jacquelyn Carr got right to the point at the start of her October 19 Maimonides Society Brunch and Learn presentation on Ashkenazi Jews and pancreatic cancer. “Do Jews need to worry about pancreatic cancer?” she asked. In short, the answer is no.

The longer answer is that pancreatic cancer disproportionately affects Ashkenazi Jews, but that only makes their chances of developing it slightly more likely than very unlikely. “Pancreatic cancer is rare,” Carr said, “even in Jews.”

Aaron Gorodzinksy, the Jewish Federation of the Lehigh Valley staff member who oversees the society of healthcare professionals, welcomed the members back from their summer break for their first program of the Federation’s new fundraising year. And this fundraising year includes the 40th anniversary of the 1986 founding of the society in the Lehigh Valley—the very first Maimonides Society in North America.

Dr. Zach Goldsmith, Maimonides Society president, called special attention to the group of local doctors who succeeded in banding together in the 1980s to support Israel and strengthen Jewish communal life here and elsewhere. “This is certainly an excellent year for Maimonides,” he said. “Stay tuned for our plans on how we’re going to celebrate and honor our founding members.”

Then Aaron Gorodzinsky transitioned into the weighty subject matter Carr was about to discuss. “Several members of my family have suffered pancreatic cancer and the devastating consequences,” he said. 

With this sobering reality noted, Carr put her title for the presentation up on the big screen behind her: “Pancreatic Cancer and Being Jewish: Another Thing to Worry About?” She explained, “Throughout my presentation I’ll be talking about how you don’t need to worry about it so much.”

Carr, a surgical oncologist with St. Luke’s University Health Network and member of the St. Luke’s multidisciplinary cancer team who specializes in gastrointestinal malignancies, including pancreatic cancer, followed up with this conclusion: given her specialty and the normal chain of referrals through medical practitioners, you don’t want to end up being sent to see her. “Most of the time if you’re in my office,” she said, “something sad is happening with your pancreas.”

When there’s a problem with the pancreas, it’s usually discovered incidentally when a patient experiencing pain in their abdomen has a CT scan to determine the cause and the film reveals an anomaly in the pancreas region. Carr said, “Most people who have incidental findings—those things are benign.” 

The more obvious, and serious, sign of a pancreas problem is “painless jaundice,” Carr said. “You’re not having symptoms and suddenly your eyes are yellow and your skin is yellow.” Visit the doctor right away. It can be a sign that a cancer in the pancreas is blocking the bilirubin produced in the liver from passing through it into the intestines. The bilirubin then backs up in the blood and causes the yellowing. A CT scan will typically follow. 

Depending on the specific findings of any CT scan, the next step may be a biopsy to diagnose the tissue. “We never say anyone has cancer until we see it under the microscope,” Carr said. Some growths may not turn up as cancer, but Carr may need to determine whether she thinks they’ll develop into it.

If it is cancer, chemo is the automatic treatment. “Everyone with pancreatic cancer gets chemotherapy,” Carr said. If the patient gets chemo only, then the goal is to slow the cancer’s growth to give the patient more time and to improve quality of life. 

If surgery is done in addition to that, then the goal is a cure. But surgery is difficult, since the pancreas is surrounded by vital organs under the ribcage, centrally located so it can circulate its sugar-metabolizing hormones and enzymes for fat digestion. It’s difficult and risky to work around all those organs. 

If the cancer is located in the head of the pancreas, the patient may be a candidate for the Whipple Procedure. This is a difficult three-hour surgery, but the prognosis is good. “If you need Whipple surgery,” Carr said, “you go to someone who does it a lot, and more than likely you’ll be fine and you’ll live.”

The reason people of Ashkenazi Jewish ancestry are disproportionately affected by pancreatic cancer is that they have an increased risk of BRCA (BReast CAncer) mutations. “BRCA is a tumor-suppressor gene,” Carr said, and everyone has it. A mutated BRCA does not work properly and can allow cancers to develop, including pancreatic cancer. 

So what do you do about all this? Carr said that all Jews are eligible for genetic testing. “If you’re Jewish,” she said, “you go to your doctor and say, ‘I want genetic testing. I meet the criteria.’” 

Genetic testing is typically a saliva swab. Sometimes blood may be drawn. You’ll get a full report and then see a genetics counselor who will tell you what to do next. 

Carr did point a caveat with the testing: “If you show the mutation, there’s a risk you might not get life insurance.” On the other hand: the sooner the better for possible treatment of cancer. 

Further tests may follow. “If you have a family history of pancreatic cancer or you have a BRCA mutation,” Carr continued, “you meet the criteria for screening.” That screening usually includes a CT scan.

The bottom line of this day’s discussion was unavoidable. “Most people who get pancreatic cancer are going to die of pancreatic cancer,” Carr said. “That’s the truth.” 

Fortunately, whatever a person’s problem may be, if there is one at all, it’s probably not pancreatic cancer. 

If you’re a medical professional in the Lehigh Valley, now is a great time to join the Maimonides Society. The new fundraising year has just begun, with months of upcoming educational, social, and other events on the way, and the 40th anniversary celebration is just around the corner. Find out more by contacting Aaron Gorodzinsky at [email protected] or 610-821-5500, ext. 336.