Epidemiologist Margaret Du says women with PCOS may benefit from increased surveillance for pancreatic cancer, although more research is needed.
- Polycystic ovary syndrome (PCOS) is a hormonal disorder that affects 1 in 10 women of childbearing age.
- A study suggests PCOS may be associated with as much as double the risk of pancreatic cancer.
Memorial Sloan Kettering Cancer Center (MSK) epidemiologist Mengmeng “Margaret” Du discusses her team’s new research suggesting a link between polycystic ovary syndrome (PCOS) and pancreatic cancer.
What is polycystic ovary syndrome (PCOS)?
Polycystic ovary syndrome, also called polycystic ovarian syndrome, is caused by an imbalance of reproductive hormones. It is one of the most common causes of female infertility, affecting as many as 5 million women of reproductive age in the U.S.
Most of the symptoms of PCOS are caused by higher-than-normal levels of hormones called androgens.
Symptoms of PCOS may include:
- Irregular periods or no periods
- Small fluid-filled cysts within the ovaries
- Excessive hair growth (hirsutism) — usually on the face, chest, back, or buttocks
- Weight gain
- Oily skin or acne
- Difficulty getting pregnant
Diagnosing PCOS
There’s no single test to specifically diagnose polycystic ovary syndrome. A doctor will usually make a diagnosis based on whether you have several of the symptoms listed above.
Treating PCOS
Treatment for PCOS usually focuses on managing the symptoms that concern you, either through lifestyle changes or medication.
What causes PCOS?
We don’t know what causes PCOS, but several factors seem to be involved. Many people with PCOS have high levels of insulin because their bodies’ cells have become resistant to it — a condition that is often worsened by obesity. People with PCOS also often have chronic low-grade inflammation, another byproduct of obesity. We think genetics play a role because it’s common for PCOS to appear in multiple members of an immediate family — sisters, mothers, and daughters.
MSK research examined the risk of pancreatic cancer in women diagnosed with PCOS
Research had already shown that PCOS is associated with several cancers, most strongly with uterine (endometrial) cancer and slightly less so with ovarian cancer and breast cancer.
In 2019, researchers in Sweden reported that people with PCOS had a 3.4 times higher risk of developing pancreatic cancer. But that study included only five people with both PCOS and pancreatic cancer — not nearly enough to draw a strong conclusion. We wanted to see if we could get better evidence by studying a much larger group of people.
We compared data from 446 people treated for pancreatic cancer at MSK with 209 people who had no history of cancer. We found that having PCOS nearly doubled a person’s risk of developing pancreatic cancer. We reported these findings in JAMA Oncology on October 6, 2022.
It is important to note that while millions of women have PCOS, pancreatic cancer remains a rare disease, with around 62,000 cases diagnosed every year — about half of them in women.
Is there a biological connection between PCOS and pancreatic cancer?
To be clear, we are not suggesting that PCOS is a precursor to pancreatic cancer in the same way colon polyps can develop into colon cancers.
We hypothesize that some of the underlying causes of PCOS may also contribute to pancreatic cancer. Some of the factors that may cause both diseases include:
- Metabolic problems, such as failure to properly break down fats or process insulin.
- Chronic inflammation, which we know can contribute to both conditions.
We were surprised to see that the association between PCOS and pancreatic cancer was not driven by obesity and diabetes. Therefore, we believe there may be some other underlying metabolic dysfunction at work.
Next steps in researching the connection between PCOS and pancreatic cancer
To identify a biological mechanism and confirm cause and effect, researchers will need to design experiments in animals. We will continue looking for the connection between the two diseases in a larger group of people. Our study was retrospective, meaning that we asked participants questions about the past — specifically, whether they ever had PCOS. There needs to be some prospective studies as well — where people with and without PCOS are followed over time to see if more women with PCOS develop pancreatic cancer.
What could someone with PCOS do to reduce pancreatic cancer risk?
If we can prove that PCOS is a marker for increased pancreatic cancer risk, it could mean that women with PCOS may benefit from increased surveillance for pancreatic cancer. Right now, there is no widespread surveillance for pancreatic cancer because studies are still underway to assess if there’s a benefit. But certain high-risk people — like those with a family history or people with certain genetic mutations such as BRCA1 and BRCA2 — are encouraged to be more vigilant in screening for the disease.
What can MSK do for people with a high risk of pancreatic cancer?
At MSK, the Pancreatic Tumor Registry has been enrolling high-risk people in a long-running surveillance study. They come in every one to two years and have an MRI to check for precancerous lesions. Any that are found are monitored to see if the lesions change over time or require intervention. We need to do more research, but what we have learned combined with data from the Swedish study suggests that it may be worthwhile for clinicians to be mindful of pancreatic cancer risk when patients have PCOS.
We urgently need to find ways to diagnose pancreatic cancer earlier. Right now, only 11% of people with pancreatic cancer survive five years after diagnosis. Registries like ours, which began in 2002, have been invaluable for insights into genetic, environmental, and lifestyle factors that increase risk. They offer hope for this very scary disease. We’re very grateful to everyone who joined this study — people who came to MSK and dedicated their time to help us find answers.
