PATIENTS FIRST
Decision point: Cancer some day or diabetes now? SURGEON HAS PANCREAS REMOVED TO BEAT THE ODDS BY AMBER SMITH
r. David Halleran, MD faced a decision similar to the one made by Angelina Jolie. The actress had a double mastectomy because of her genetic predisposition to breast cancer. The doctor elected to have his pancreas removed due to a strong family history of pancreatic cancer, one of the most deadly cancers. The difference was that Halleran knew he already had advanced pre-cancer in his pancreas before it was removed.
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“The reality is, you are not doing this on a lark. The other option, to do nothing, is much worse,” says Halleran, a colorectal surgeon in his 30th year of practice. Halleran, 62, had surgery eight years ago, in July 2005. His father, Dr. Leo Baker Halleran, MD, was 58 when he died in 1974; his brother, Leo Baker Halleran, Jr., was 50 when he died in 1999. Both men developed cancer in the exocrine cells of the pancreas. The Halleran patriarch had been a solo internal medicine doctor, practicing in New York City. Some of his patients told him he didn’t look well. He kept working until his skin and eyes turned yellow. The sudden jaundice sent him to the hospital, where he underwent surgery and died. David Halleran – the middle child of five – was in his second year of medical school. “I like to think he knew he was sick,” he says of his father, “although there is a lot of self denial when it comes to your own health.”
Pancreatic cancer is so deadly because most people don’t find out they have it until it has spread. Symptoms can mimic those of an ulcer, stomach flu or indigestion. The position of the pancreas deep in the belly makes it difficult for tumors to be felt or seen. Even reaching the pancreas for a biopsy of its tissue can be complicated. David Halleran believed that the pancreatic cancer that killed his father and brother was somehow related to their smoking—even though he knew up to 10 percent of cases were caused by inherited DNA changes. He maintained that he was in good health. It was his younger brother who began researching. Michael Halleran, PhD – an academic of Greek and Roman classics who now is provost for the College of William & Mary — taught at the University of Washington in Seattle at the time, and one of the physician scientists there happened to be studying familial pancreatic cancer. To be involved in Dr. Teresa Brentnall’s study, a person had to have at least two close relatives who had pancreatic cancer. So Michael Halleran enrolled. Brentnall is conducting surveillance of families with hereditary pancreatic cancer, hoping it will lead to Continued on page 18
His father had jaundice but no pain, which Halleran learned was indicative of cancer in the “head” of the pancreas. Twenty-five years later, Halleran’s older brother developed upper back pain and jaundice. That’s more typical of cancer in the “tail” of the pancreas. The older brother, Leo Baker Halleran, Jr., had the tail of his pancreas removed during an operation in Boston. He died less than a year afterward, in 1999, a few weeks after the family celebrated his 50th birthday. The incidence of pancreatic cancer has been slowly increasing over the past 10 years, and survival rates remain grim. “It’s a very unforgiving cancer, as far as mortality,” Halleran says. This year more than 45,000 Americans are expected to be diagnosed with cancer of the pancreas, and more than 38,000 Americans will die from the disease, according to the American Cancer Society.
David Halleran MD frequents the Central New York Regional Market year-round on Saturdays in Syracuse. fall 2013
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