Pancreatic cancer claims the fourth highest spot on the list of cancer-related mortality, despite the fact that it doesn’t even make the top ten for incidence. This glaring disparity is largely due to the fact that over 50% of pancreatic cancers are discovered at a late stage, when 5-year survival rates drop from the disease average of 8% to a mere 2% (Siegel et al. 2002).
Pancreatic cancer mortality has continued to rise over the past two decades (Howlader et al. 2015), a sharp contrast from the majority of cancers, where survival rates have risen in recent years.
Cancer of the Pancreas Photomicrograph of pancreatic adenocarcinoma, an invasive malignant tumor associated with a poor prognosis. © David Litman/shutterstock.com
A major factor underlying the risk of pancreatic cancer is diet and exercise. Obesity, type II diabetes, and hyperglycemia are known risk factors of the disease (Bardeesy et al. 2002, Chang et al. 2016). Insulin is produced in the pancreas and thus diabetes and hyperglycemia negatively impact the homeostasis of this organ.
Due to the fact that late diagnosis often renders surgical and pharmacological treatment ineffective, risk reduction may be a critical method of improving pancreatic cancer survival. Reducing sugar intake could potentially be a way of decreasing the risk of pancreatic cancer.
One method of reducing sugar intake, other than abstinence, is the replacement of sugar with artificial sweeteners in soft drinks, candies, and other food stuffs. Due to the difficulty of maintaining abstinence from sugar in a dieting regimen, replacement may be a more reliable and effective method of reducing glucose intake.
However, significant controversy exists in the literature and public opinion of artificial sweeteners, with some studies indicating carcinogenic properties while others claim anti-tumor effects or no effect in either direction (Tandel 2011, Mallikarjun et al. 2015).
Therefore, Dr. James Dooley and colleagues at the University of Leuven in Belgium sought to determine whether aspartame or stevia, two commonly used artificial sweeteners, produce an effect on pancreatic cancer progression in a mouse model.
The authors found no significant difference between mice given regular water and those given water with either of the sweeteners added to it. The rates of incidence, age of onset, growth rate, histopathological hallmarks, and mortality were similar across all groups of animals based upon MRI data obtained using a Bruker Biospin 9.4 T Biospec small animal MR scanner (Dooley et al. 2017).
Magnetic resonance imaging (MRI) is a staple of cancer detection and monitoring in both humans and animal models. This non-invasive technique allows clinicians and researchers to determine the location, size, and progression of tumors in three dimensions without the need for harmful radiation and may provide more accuracy in separating pancreatic tumors from benign lesions.
In addition, patients who undergo surgery have significantly higher survival rates than the average for pancreatic cancer (Yeh et al. 2017), highlighting the need for MRI, which can aid clinicians in determining if a patient is eligible for a surgical intervention.
Importantly, Dr. Dooley and his colleagues acknowledge that their study did not compare artificial sweeteners to sugar intake in pancreatic cancer. Due to the role of glucose intake in pancreatic risk, glucose replacement with artificial sweeteners would be expected to provide a far greater benefit than a simple addition of sweeteners to an existing diet. In addition, the majority of control mice given regular water survived to the experimental end-point, reducing the ability to accurately detect any decrease in mortality in this study.
The question remains, can sugar replacement with artificial sweeteners reduce the risk and therefore the mortality rates of pancreatic cancer? In order to fully understand the potential impact of artificial sweeteners in this context, it may be important to determine the extent to which at risk individuals actually use artificial sweeteners to replace glucose in their diets.
If the controversy over artificial sweetener safety can be reconciled and sugar replacement is found to reduce pancreatic risk, this preventative measure may provide significant benefit in people at risk of developing pancreatic cancer. Future studies to determine the potential benefit of such a glucose replacement are still needed, and the use of MRI scanners such as those made by Bruker will undoubtedly be vital to properly locate and follow tumors in live animals and humans alike.
The versatility of MRI will allow longitudinal studies to evaluate the relationship between glucose replacement and rates of incidence, age of onset, growth rate, histopathological hallmarks, mortality and more in such studies of pancreatic cancer.
- Howlader N, Noone AM, Krapcho M, et al. SEER Cancer Statistics Review, 1975-2012. Bethesda, Bethesda, MD: National Cancer Institute. 2015.
- Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016;66:7–30.
- Dooley J, Lagou V, Dresselaers T, Van Dongen KA, Himmelreich U, and Liston A. No Effect of Dietary Aspartame or Stevia on Pancreatic Acinar Carcinoma Development, Growth, or Induced Mortality in a Murine Model. Frontiers in Oncology. 2017;7:1-7.
- Bardeesy N, DePinho RA. Pancreatic cancer biology and genetics. Nat Rev Cancer. 2002;2:897–909.
- Tandel KR. Sugar substitutes: health controversy over perceived benefits. J Pharmacol Pharmacother. 2011;2:236–43.
- Chang SC, Yang WV. Hyperglycemia, tumorigenesis, and chronic inflammation. Crit Rev Oncol Hematol. 2016;108:146-153.
- Mallikarjun S, Sieburth RM. Aspartame and risk of cancer: a meta-analytic review. Arch Environ Occup Health (2015) 70(3):133–41.
- Yeh R, Steinman J, Luk L, Kluger MD, Hecht EM. Imaging of pancreatic cancer: what the surgeon wants to know. Clin Imaging. 2017;42:203-217.
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