Pancreatic Cancer Screening

Shin, Eun Ji; Canto, Marcia Irene

doi:10.1016/j.gtc.2011.12.001

Cited by 62 publications

(49 citation statements)

References 116 publications

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“…Furthermore, serum biomarkers may be used alongside imaging tests to enhance diagnostic accuracy. Although known biomarkers such as CA19-9 have not proven to be effective for early detection, new and evolving biomarkers – such as circulating tumor cells – demonstrate promise for early detection efforts (7, 62). Our model can be further developed to evaluate a wide spectrum of possible screening strategies and identify optimized strategies that are tailored to individual patient risk.…”

Section: Discussionmentioning

confidence: 99%

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Targeted Screening of Individuals at High Risk for Pancreatic Cancer: Results of a Simulation Model

Pandharipande¹,

Heberle

Dowling³

et al. 2015

Radiology

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Purpose To identify when, from the standpoint of relative risk, MRI-based pancreatic cancer screening may be effective in patients with a known or suspected genetic predisposition. Methods We developed a Markov model of pancreatic ductal adenocarcinoma (PDAC). The model was calibrated to National Cancer Institute Surveillance, Epidemiology and End Results registry data and informed by the published literature. A hypothetical screening strategy was evaluated in which all population individuals underwent one-time MRI screening at age 50. Screening outcomes for individuals with average PDAC risk (base case) were compared to those with increased risk, to assess for differential benefits in populations with a known or suspected genetic predisposition. Effects of varying key inputs, including MRI performance, surgical mortality, and screening age, were evaluated in sensitivity analysis. Results In the base case, screening resulted in a small number of cancer deaths averted (39/100,000 (men), 38/100,000 (women)) and a net decrease in life expectancy, driven by surgical deaths from false-positive results (-3 days (men), −4 days (women)). Life expectancy gains were achieved if individuals’ risk for PDAC exceeded 2.4× (men) or 2.7× (women) that of the general population. When relative risk increased further, for example to 30× that of the general population, averted cancer deaths and life expectancy gains increased substantially (1,219/100,000, 65 days (men) and 1,204/100,000, 71 days (women)). Results were additionally sensitive to MRI specificity and the surgical mortality rate. Conclusions Although PDAC screening with MRI for the entire population is not effective, individuals with even modestly increased risk may benefit.

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Section: Discussionmentioning

confidence: 99%

“…Dominant precursors include pancreatic intraepithelial neoplasia (PanIN, solid) and intraductal papillary mucinous neoplasms (IPMNs, cystic) but most are indolent and will not progress to cancer (5, 7). While PanINs are not reliably seen at imaging, improvements in cross-sectional imaging have led to increased detection of IPMNs (8–10).…”

Section: Introductionmentioning

confidence: 99%

Targeted Screening of Individuals at High Risk for Pancreatic Cancer: Results of a Simulation Model

Pandharipande¹,

Heberle

Dowling³

et al. 2015

Radiology

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“…As with many other cancers, patients who are diagnosed with localized disease have higher survival (24% survival at 5 years), providing a strong rationale to focus research efforts on identifying early disease. To date, there is no screening test available for pancreatic cancer in the general population; screening for high-risk individuals exists, but is limited to academic medical centers as various strategies of differing effectiveness are still being evaluated (2). The obvious and urgent need for early biomarkers of detection has led many researchers to consider and sort through thousands of potential blood biomarkers; but to date, none have been validated for clinical use, and potentially promising biomarkers (3) are only rarely tested in pre-diagnostic blood samples (4).…”

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confidence: 99%

Microbiota, Oral Microbiome, and Pancreatic Cancer

Michaud

Izard

2014

The Cancer Journal

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Only 30% of patients diagnosed with pancreatic cancer survive one year post-diagnosis. Progress in understanding the causes of pancreatic cancer has been made, including solidifying the associations with obesity and diabetes, and a proportion of cases should be preventable through lifestyle modifications. Unfortunately, identifying reliable biomarkers of early pancreatic cancer has been extremely challenging, and no effective screening modality is currently available for this devastating form of cancer. Recent data suggest the microbiota may play a role in the disease process, but many questions remain. Future studies focusing on the human microbiome, both etiologically and as a marker of disease susceptibility, should shed light on how to better tackle prevention, early detection, and treatment of this highly fatal disease.

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“…Furthermore, serum biomarkers may be used alongside imaging tests to enhance diagnostic accuracy. Although known biomarkers such as CA19-9 have not proved to be effective for early detection, new and evolving biomarkers-such as circulating tumor cells-demonstrate promise for early detection efforts (7,62). Our model can be further developed to evaluate a wide spectrum of possible screening strategies and identify optimized strategies that are tailored to individual patient risk.…”

Section: Discussionmentioning

confidence: 99%

“…lesions), but most are indolent and will not progress to cancer (5,7). Although pancreatic intraepithelial neoplasia is not reliably seen at imaging, improvements in cross-sectional imaging have led to increased detection of IPMNs (8)(9)(10).…”

Section: Implication For Patient Carementioning

confidence: 99%

Targeted Screening of Individuals at High Risk for Pancreatic Cancer: Results of a Simulation Model

Pandharipande¹,

Heberle²,

Dowling³

et al. 2016

Radiology

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Purpose:To identify when, from the standpoint of relative risk, magnetic resonance (MR) imaging-based screening may be effective in patients with a known or suspected genetic predisposition to pancreatic cancer. Materials and Methods:The authors developed a Markov model of pancreatic ductal adenocarcinoma (PDAC). The model was calibrated to National Cancer Institute Surveillance, Epidemiology, and End Results registry data and informed by the literature. A hypothetical screening strategy was evaluated in which all population individuals underwent one-time MR imaging screening at age 50 years. Screening outcomes for individuals with an average risk for PDAC ("base case") were compared with those for individuals at an increased risk to assess for differential benefits in populations with a known or suspected genetic predisposition. Effects of varying key inputs, including MR imaging performance, surgical mortality, and screening age, were evaluated with a sensitivity analysis. Results:In the base case, screening resulted in a small number of cancer deaths averted (39 of 100 000 men, 38 of 100 000 women) and a net decrease in life expectancy (23 days for men, 24 days for women), which was driven by unnecessary pancreatic surgeries associated with false-positive results. Life expectancy gains were achieved if an individual's risk for PDAC exceeded 2.4 (men) or 2.7 (women) times that of the general population. When relative risk increased further, for example to 30 times that of the general population, averted cancer deaths and life expectancy gains increased substantially (1219 of 100 000 men, life expectancy gain: 65 days; 1204 of 100 000 women, life expectancy gain: 71 days). In addition, results were sensitive to MR imaging specificity and the surgical mortality rate. Conclusion:Although PDAC screening with MR imaging for the entire population is not effective, individuals with even modestly increased risk may benefit.q RSNA, 2014

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Pancreatic Cancer Screening

Cited by 62 publications

References 116 publications

Targeted Screening of Individuals at High Risk for Pancreatic Cancer: Results of a Simulation Model

Targeted Screening of Individuals at High Risk for Pancreatic Cancer: Results of a Simulation Model

Microbiota, Oral Microbiome, and Pancreatic Cancer

Targeted Screening of Individuals at High Risk for Pancreatic Cancer: Results of a Simulation Model

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