Ask the doctors: Can AI detect pancreatic cancer earlier?

Q: A dear friend was diagnosed with pancreatic cancer. It was so advanced, he died just a month later. I recently saw a discussion on television about using AI to detect pancreatic cancer early, while it is still curable. How would that work?

A: With a five-year survival rate of only 9%, pancreatic cancer is among the deadliest of the major cancers. It accounts for just 3% of all cancers diagnosed in the United States, which makes it fairly rare. And yet it is the third-leading cause of cancer-related deaths, behind lung and colorectal cancer.

One of the main factors driving such a high mortality rate is the difficulty of catching this cancer at an early stage. This is due, in large part, to the location of the organ. The pancreas itself is small, just 6 inches long. It is situated deep inside the abdomen, tucked among the liver, spleen, small intestine and stomach. This makes it impossible to see without the benefit of imaging tests. Adding to the challenge is that early-stage pancreatic cancer causes few, if any, symptoms. When symptoms do begin to appear, the cancer is usually quite advanced. At that point, it has often begun to spread to other areas of the body.

In the past year, several medical institutions have reported success in developing AI technology to improve pancreatic cancer outcomes. For those who are not familiar, AI stands for artificial intelligence. It is a form of targeted problem-solving that harnesses the power of computers and computer science to analyze vast amounts of data.

Last fall, the Mayo Clinic announced the development of AI technology to analyze CT scans of patients suspected to have pancreatic cancer. Researchers “trained” their AI model using a data set of 3,000 CT scans of patients with pancreatic tumors. The resulting technology was then tested using CT scans of both healthy and diseased pancreases. The AI model, with an accuracy rate of 87%, detected tumors between three months and three years sooner than the real-world diagnosis had found them.

Researchers from MIT and a Harvard-affiliated hospital approached the problem from a different angle. Their goal was to identify people at high risk of developing pancreatic cancer. That's important because under current guidelines, only people with first-degree relatives with the disease or a known gene mutation that causes it are routinely screened. Health data show that's just 10% of the population that goes on to develop this type of cancer.

Turning to AI, the Boston researchers created a neural network trained to identify patients at high risk of developing pancreatic cancer. They did this using anonymous electronic health records from 55 health care organizations in the U.S. The neural network was able to identify patients at risk of developing pancreatic cancer up to 18 months sooner than their real-world diagnosis of the disease.

It will take time for these AI-based approaches to go into widespread use. However, these results signal a possible turning point in early pancreatic cancer diagnosis.

Gut flora takes a hit from antibiotics

Q: I got a tick bite, and because there's Lyme disease in our area, my doctor put me on antibiotics. It prevented Lyme disease, but I'm worried about what it did to my gut microbiome. How long does it take to recover? Can I do anything to help?

A: Over the last few decades, we have become increasingly aware of how the trillions of microbes that live in the human gut support our physical and mental health. These diverse colonies of microorganisms play key roles in physiology, nutrition, digestion, metabolism, immune function, hormone balance, neural activity and disease prevention. This has led to much speculation about what happens to the gut microbiome when antibiotics are needed to control a bacterial infection.

Two things turn out to be true. One is that antibiotics save millions of lives each year. The other is that using them disrupts the complex ecosystems of the gut microbiome. This means not just a decrease in the numbers of microorganisms in the large intestine, but also a decline in their diversity.

The good news is that researchers have found the gut microbiome is resilient and, over the course of several months, will gradually recover. The speed and scope of that recovery is affected by several factors. The type of antibiotic used and how frequently play a role. Eating a fiber-deficient diet prior to antibiotic treatment also leads to a slower recovery. Older adults and infants and young children may also see a delayed return of their gut flora.

You can support the recovery of your gut microbiome in several ways. Although logic suggests taking probiotics, researchers have found this can actually delay recovery. It has been found that following a course of antibiotics, the limited numbers of bacteria in probiotic products can colonize the gut. This markedly slows the balanced return of the diverse and complex colonies of microbes that are unique to each person's microbiome.

A more effective approach is to feed your gut — literally. Concentrate on a wide and varied range of prebiotic foods. These include the fresh vegetables, leafy greens, legumes, nuts and fruit that contain the fiber and micronutrients our gut flora thrive on. Include plenty of fermented foods, as well, such as yogurt, kefir, kombucha, pickles, miso and sauerkraut. Be sure to choose products with live cultures.

Physical activity has been shown to greatly improve gut health. Choose a well-rounded program of aerobic activity to get your heart pumping, strength training to build muscle strength and activities to enhance and preserve flexibility and agility.

Studies show environmental factors also play a significant role in healing an injured gut. This includes being around and interacting with animals, gardening and spending time outdoors and in nature. These expose you to a wide array of the “good” microbes that help boost gut diversity. So does being among other people who share their microbes with every breath, kiss, hug and handshake.

There are no shortcuts to good gut health. Eat well, take care of yourself and be patient. Your gut will thank you.

• Dr. Eve Glazier is an internist and associate professor of medicine at UCLA Health. Dr. Elizabeth Ko is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu.

© 2024 UCLA Health. Distributed by Andrews McMeel Syndication