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June 30, 2023

Using Epidemiology to Fight Pancreas Cancer

It only took one statistic to get Meg Mandelson, PhD, interested in studying pancreas cancer. 

“Five-year survival rates have greatly improved for almost every cancer over the past two decades,” she says. “Pancreas cancer is one of the few that hasn’t.” 

Statistics like these are the bread and butter of Dr. Mandelson’s work. She’s a cancer epidemiologist, which means she analyzes information from lots of people who have had cancer. The goal is to find patterns that could explain why they got sick and what treatments are most effective. This work is particularly crucial in pancreas cancer because it is still so hard to detect — too often it isn’t diagnosed until the cancer has progressed to the point that it’s very difficult to treat.

Featured Chart Survival Improving Most Cancers
While 5-year survival rates have improved for most cancers over the past 40 years, those for pancreas cancer show little improvement. BRI and a team of clinicians at Virginia Mason Medical Center are working to change that.

“Pancreas cancer is fascinating from a biological standpoint because it’s different from many other solid tumors,” Dr. Mandelson says. “There are treatments that are effective in cell culture but show little or no benefit when tested in patients. A recent review suggested that only 3% of treatments tested in clinical trials clear the bar for FDA approval. There’s also evidence pancreas cancer spreads early, but in amounts so small it is undetectable by current imaging and clinical biomarkers. That could explain why some patients undergo treatment and scans show that they are cancer-free, but their cancer comes back soon after.”

Dr. Mandelson joined BRI’s team in 2020, aiming to find answers and hope for this deadly cancer. Now she’s working on several innovative pancreas cancer studies and leads VM BRITE, a cancer biorepository that supports research at VMFH and BRI.

Four Studies Changing the Odds in Pancreas Cancer

Dr. Mandelson has teamed up with Vincent Picozzi, MD, director of the Pancreaticobiliary Cancer Center of Excellence at Virginia Mason Franciscan Health (VMFH), other VMFH clinicians, and scientists across the country to improve detection and treatment of pancreas cancer in many ways: 

  1. Improving Early Detection: This project analyzes imaging studies, clinical records and biological data to find patterns that could illuminate warning signs of pancreas cancer and help detect it earlier. 
  2. Combining Chemotherapy Drugs: Aggressive chemotherapy can be effective for pancreas cancer. But it can have severe side effects that not all patients can tolerate. This research found that alternating between the more and less aggressive treatments could lead to good outcomes with fewer side effects for many patients, including those who are older or have multiple health conditions. 
  3. Using Chemotherapy Before Surgery: Using chemotherapy to shrink tumors and then performing surgery is an effective treatment method in many types of cancer. But because chemotherapy can have severe side effects, the benefits can outweigh the risks. This study dives into whether this approach is effective for pancreas cancer and, if so, in which patients it would work best for. 
  4. Finding Better Treatment Faster: BRI and VMFH are part of an innovative pancreas cancer trial called Precision Promise. This trial uses a Bayesian approach, which tests different therapies in different patients over the same time period. If one treatment isn’t working, they’ll stop testing that treatment. If one looks promising, they’ll put more patients into that group to gather more data faster. This approach helps scientists find the best treatments more efficiently. 

Growing Our Cancer Biorepository

VM BRITE was established in 2018 to expand BRI’s cancer research and explore the link between cancer and autoimmunity. Autoimmunity happens when the immune system is too active, while cancer happens when it’s not active enough. Studying both gives us insight into how we can move the immune system closer to just the right amount of activity. 

VM BRITE already has samples from more than 800 patients with many types of cancer. Patients also consent to medical record review and share information about their medical history, family history and other information that gives researchers deeper insight into the disease.

Dr. Mandelson hopes to expand this biorepository, in collaboration with BRI investigators and external scientists in academia and industry, gathering more information about long-term health outcomes and survival rates. 

“Our goal is to collect more information from patients over time, so we can better understand how they do five, 10, 15 years after treatment,” she says. “This opens up the potential for a much deeper understanding about features of tumor tissue collected through VM BRITE and response to specific treatments.” 

She hopes these efforts will ultimately improve the statistics for pancreas and other types of cancer. 

“BRI’s collaborative approach and deep understanding of the immune system has the potential to make groundbreaking contributions to cancer and targets for treatment,” Dr. Mandelson says.

Biorepositories By the Numbers
Biorepositories are banks of blood and tissue samples. BRI has some of the most robust biorepositories in the world. They fuel our research by enabling our team to study samples from real people, accelerating the process from lab research to life-changing treatment.




disease areas


years of research

Biorepositories By the Numbers


healthy control volunteers





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