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Doctor Patient Relationship

In 2017, Nate Link, MD, a husband and father of three, sensed a looming health crisis.

After losing both his father and uncle to pancreatic cancer, the 60-year-old chief medical officer of NYC Health + Hospitals/Bellevue feared he might be next. He knew that pancreatic cancer often ran in families, had single-digit survival rates, and rarely caused symptoms until it was too late. What he didn’t know was how difficult it would be to find a clinical setting where he could have his personal risk assessed. He searched exhaustively, but “there really wasn’t any such thing as pancreatic cancer screening,” he says. “I just couldn’t find a protocol.”

Then, last fall, in a serendipitous twist, the protocol found him. During a clinical meeting at Tisch Hospital, he overheard colleagues discussing a new screening program at NYU Langone Health for people at high risk for pancreatic cancer, led by Diane Simeone, MD, director of the Pancreatic Cancer Center at Perlmutter Cancer Center. Dr. Link emailed Dr. Simeone right away, explaining his family history. “She said I absolutely would qualify for the program, and I should just come on in,” he recalls.

The Pancreatic Cancer Center, launched in 2017, is among a small number of centers in the country to offer an active screening program supported by a dedicated genetics counselor and a robust research team. “For highrisk patients, it was generally thought that there was nothing we could do, so patients didn’t seek counsel,” says Dr. Simeone, the Laura and Isaac Perlmutter Professor of Surgery. “Now, we can find lesions before they turn cancerous. We have more to offer.” Last year, the center treated more than 400 patients, all while researching new risk factors for pancreatic cancer and trying to develop a blood test for its early detection.

In Dr. Link’s case, he tested negative for all of the genes associated with pancreatic cancer (about 15 are known so far), but because of his family history, Dr. Simeone advised a series of imaging tests, a recommendation that would validate Dr. Link’s sense of urgency. An endoscopic ultrasound revealed a cystic mass the size of a golf ball growing on his pancreas. “It was a classic premalignant lesion,” Dr. Link recalls. “The tumor was benign, but it had about a 50% chance of turning cancerous, and I wasn’t about to take that risk.”

So, last March, Dr. Link underwent the Whipple procedure, a five-hour operation in which Dr. Simeone removed the head of his pancreas, excising the growth, and then reconnected the organ to his digestive system. “Even though it’s a very drastic intervention, I had no difficulty making the decision to have it done,” Dr. Link says. “I had full confidence in Dr. Simeone. She’s one of the most experienced pancreatic cancer surgeons in the country.”

The surgery went smoothly, and after a week of recuperating in the hospital—a typical amount of time required to allow the digestive system to adjust— Dr. Link was back at home. Remarkably, just four weeks later, he was hiking 10 miles a day in the South of France on a much-anticipated family vacation, an event that kept him motivated during his recovery. “My goal was to be with my family,” he says. “Because of that, I was pretty aggressive in walking and getting up on my feet as soon as I got home. I was walking more and more each day.”

Today, Dr. Link is back at work and feels fully restored, without any physical limitations. “My digestion and activity level are completely normal,” he says. Beyond his physical health, he’s grateful for the peace of mind that came with the intervention. “A lesion can turn fast,” he says. “There’s a point where it crosses over the threshold and becomes malignant. Will that moment come in the next three months or the next 30 years? It’s impossible to predict, and pancreatic cancer has the worst survival rate of any cancer. So if there is any cancer I would want to prevent, this is the one.”

“For high-risk patients, it was generally thought that there was nothing we could do, so patients didn’t seek counsel. Now, we can find lesions before they turn cancerous. We have more to offer.”

The Promise of Personalized Medicine for Pancreatic Cancer

Of the more than 56,000 cases of pancreatic lesions diagnosed each year in the US, less than 1% of them are identified before they turn malignant. Some 80% of malignancies are diagnosed at a late stage. “These patients need new approaches to early detection and new treatments more quickly,” says Diane Simeone, MD, director of the Pancreatic Cancer Center at Perlmutter Cancer Center. “One important way we can do that is by putting patients at the center of our research.” To that end, Dr. Simeone also serves as chair of the Steering Committee of Precision Promise, a new clinical trial consortium funded by the Pancreatic Cancer Action Network. When Precision Promise launched this summer, Perlmutter Cancer Center became a lead site among the 14 participating institutions nationwide. Unlike traditional trials that test only one or two treatments at a time, Precision Promise is evaluating multiple experimental therapies simultaneously, with the goal of delivering personalized medicine that’s more likely to be effective. “We’ll learn and adapt as we go,” says Dr. Simeone. “It’s a whole new way to tackle pancreatic cancer.”

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