Sven-Göran Eriksson pancreatic cancer diagnosis, can you reduce the risks of getting it?

It is disheartening to learn that Sven-Göran Eriksson, an iconic figure in football management, has received a terminal pancreatic cancer diagnosis. Perhaps, through his selfless sharing of his plight, awareness can be heightened of the various measures we can take to mitigate our own risks.

Pancreatic cancer is a particularly nasty disease as the gland lies deep in the abdomen and does not have any nerves inside it, so cancers can grow for years without any symptoms. These horrible tumours usually only present themselves after they have broken out of the gland and spread into adjacent tissues and organs, too advanced even for the most skilled surgeon to remove. At this stage, the cancer can cause unexplained weight loss, loss of appetite, and pain in the upper central part of the abdomen, strangely made worse by leaning forward. Jaundice can develop as the cancer is able to block the flow of bile in the duct from the liver to the upper part of the bowel. For the minority of men and women who are able to have curative surgery, their early cancers were discovered by chance on a CT scan taken for other reasons. In my 30 years as an oncologist, most of these scans have been taken as an investigation for bowel or prostate cancer. Ironically, it was other cancers that facilitated a cure for their pancreatic cancers - maybe another argument for attending for bowel screening and getting your PSA checked.

There have been some advances in radiotherapy that can accurately deliver a high dose, avoiding other organs. This can help slow progression and help symptoms but does not result in a cure for the vast majority of sufferers. Unfortunately, as well as being advanced, pancreatic cancers are inherently resistant to radiotherapy as well as chemotherapy, which means that responses to treatments are often short-lived. What's more, treatments for other cancers such as lung and bowel cancer have evolved to include "clever" targeted biological therapies that have dramatically improved outcomes. Disappointingly, scientists have not yet discovered a biological breakthrough for the pancreas, although intense research is ongoing in the UK and internationally as maybe hope is on the horizon.

In the meantime, the chance of surviving pancreatic cancer even for one year, is the lowest for all cancers, at about 27%. If men or women do survive 5 years, they are likely to be cured but figures published by the Office for National Statistics still show this is still only around 8% of all cases. Fortunately, pancreatic cancer is not that common. It inflicts its misery on about 10,000 people a year in the UK, that's about 3% of all cancers.

What increases our risk of pancreatic cancer?

Some medical conditions, including diabetes and chronic pancreatitis, can increase the risk of pancreatic cancer. Research also suggests that a history of hepatitis B infection and cirrhosis of the liver, normally associated with liver cancer, is also associated with pancreatic cancer. Likewise, the risk increases following chronic infection of the stomach with the harmful bacteria called H. pylori, which causes inflammation that increases the risk of stomach cancer and bowel cancer.

A family history of pancreatic cancer can increase the risk, especially if 2 or more first degree relatives have had it. In which case, you could ask your doctor for a referral for genetic testing. If this shows you carry a risky gene you could be eligible for regular screening for pancreatic as well as other cancers.

What can we do to reduce our risks of pancreatic cancer?

While it's important to note that some risk factors for pancreatic cancer are beyond our control, such as family history, medical conditions, getting older, or even being tall, there are still several things you can do to potentially lower your risk and promote your overall well-being. Although the last thing we should do is blame unfortunate men and women who get cancer, the American Cancer Society estimates that about 25-40% of cases of pancreatic cancer could be prevented by better lifestyle choices. I believe this percentage could be even higher when considering the more recently understood risks of vitamin D deficiency and poor gut health.

Ten lifestyle factors to reduce our risk of pancreatic cancer:

1. Regular exercise Daily physical activity and avoiding long periods of sedentary behaviour have been linked to a lower risk of pancreatic cancer especially in overweight individuals. Scientific studies suggest the optimal amount of moderate-intensity exercise to reduce the risk is about 2.5 - 3 hours a week. The mechanisms underlying the protective effect of exercise include:

• Reducing chronic inflammation in the body

• Enhances the formation of antioxidant enzymes that protect our DNA damage

• Improving the muscle-to-fat ratio, reducing the risk of diabetes

• Strengthens the immune system so it can kill emerging cancer cells.

  2. Smoking People associate smoking with lung cancer but smokers have a 25% increased risk of pancreatic cancer and this increases with the number of cigarettes smoked per day. If you smoke, try to explore strategies to help you quit. Smoke can also be ingested in foods. This can explain why Hungary and Eastern European countries, which have a tradition of eating smoking meat, have a higher rate of pancreas as well as stomach and bowel cancer.

3. Excess meat and particularly processed meat

These are major contributors to human disease, and it is a well-established fact that cancer rates are lower among vegetarians. Processed meats, such as many sausages, bacon, sliced ham, and all tinned meats, are the main culprits. One study published in the British Journal of Cancer estimated a 20% increased risk among enthusiastic carnivores compared to low or no meat eaters, with the risk being even higher with processed meat intake. These contain nitrites which combine with the protein in the meat to form substances called nitrosamines, and these are the real bad guys that damage our DNA, causing cancerous mutations.

The other culprits in meat are Heterocyclic amines (HCAs) and polycyclic aromatic hydrocarbons (PAHs), which are toxins created when meat is grilled, fried, or chargrilled over an open flame. Specifically, HCAs are formed when amino acids, sugars, and creatinine (found in the meat’s muscle) react at high temperatures, while PAHs are formed when fat and juices from the meat drip onto the fire and then rise up in the smoke that is generated, sticking to the surface of the meat.

4. Excess alcohol intake

Moderate to heavy alcohol consumption (>2 drinks a day) increases the risk of pancreatic cancer but people with a genetic susceptibility to alcohol common in Asian countries, may be more vulnerable to lower amounts. Regular alcohol intake contributes to weight gain and lower mood and motivation to exercise. Ethanol metabolism generates acetaldehyde and acetate which also have direct carcinogenic properties. More recently it has been discovered that alcohol can disrupt the balance of healthy to unhealthy bacteria damaging gut health.

5. Sugary drinks The proliferation of cheap sugar-packed sodas have been linked to increased risk of pancreatic cancer in several USA and Asian studies. The best evidence coming from an analysis of over 60,000 participants from Singapore who were followed for 14 years. Even just two or more sugary sodas a week increased the risk by over 10% even taking into account other risk factors such as obesity, meat intake and smoking. 

6. Fruit, vegetables, grains, legumes, herbs, and spices

These are rich in fibre, vitamins and minerals. They are also rich in natural nutrients called phytochemicals which provide the colour, aroma and taste but also have enormous health benefits including the prevention of cancer. Unlike many Asian and Mediterranean diets, the typical western diet is often deficient in phytochemicals. Ideally we should aim to have one or more vegetable, fruits with every meal of the day and use more herbs and spices. Ongoing studies are also investigating whether boosting these foods in supplement form could enhance their health properties. The multiple mechanisms responsible for their anti-cancer benefits of phytochemicals include reducing excess inflammation in the body; encouraging the production of antioxidant enzymes; improving gut flora and slowing the transport of sugar across the gut wall reducing diabetes risk.

7. Healthy gut bacteria

Many scientists have linked poor gut flora with a higher risk of many cancers including pancreas via increased systemic inflammation which causes cells to grow abnormally fast. More rapidly dividing cells are more likely to develop spontaneous mutations of DNA and have less time for them to repair themselves. On top of this, a stressed immune system lowers the chances that immune cells will recognise early cancer cells and kill them. Lots of factors affect the health of the gut from exercise, smoking, diet, weight gain and stress.

8. Exposure to some dietary and environmental chemicals, such as pesticides, benzene, certain dyes, and petrochemicals, may increase the risk of developing pancreatic cancer.

9. Maintaining high normal vitamin D levels

A number of studies have linked low vitamins with pancreatic cancer. The data implying the best protection were seen from levels over 50 nmol/L. The majority of people in Northern climates have levels significantly lower than this, especially in the Winter. Some postulate this is why pancreatic cancer is less common in countries towards the equator. Regular sun exposure (without burning) is the best way to maintain vitamin D levels but this is impractical for most people throughout the year. Vitamin D supplementation especially if combined with a probiotic which enhances its effect does seem a sensible approach to maintaining these levels.

10. Being overweight or obese

Obesity has been increasingly recognized as a strong but modifiable risk factor of pancreatic cancer and also potentially of worse outcomes after treatment. The underlying multifactorial mechanisms remain unclear, but chronic inflammation, insulin resistance and altered intestinal microbiota are all implicated. Fortunately, durable and significant weight loss has been shown to reduce the risks.

In conclusion, breakthroughs in medical research are urgently needed to detect early and treat pancreatic cancers. Sadly, these breakthroughs are likely to come too late for Sven-Göran Eriksson, but he should be applauded for raising awareness of this dreadful disease. Even though most people develop it with no fault of their own, there are clearly some lifestyle factors that can significantly modify our risks, especially if started early in life. Perhaps Svens' plight will motivate some of the millions of young football lovers across the world to consider a change for the better to protect their future selves?