Screening for Pancreatic Cancer in a High-Risk Cohort: An Eight-Year Experience

Abstract

Magnetic resonance imaging can detect small pancreatic tumors and cystic lesions, but further improvement in sensitivity is needed. An understanding of the natural history of pre-invasive lesions in members of high-risk families is necessary for developing a more effective screening program.

Diagnosis and management of pancreatic cancer

“…Prospective observational studies of screening have included patients at high risk (Box 2) and have used a combination of endoscopic ultrasound, computed tomography (CT) imaging, magnetic resonance imaging (MRI) or endoscopic retrograde cholangiopancreatography. 1,15 Relatives with a hereditary pancreatic cancer syndrome or unaffected adults in a familial pancreatic cancer kindred should be referred to a genetic counselor for further assessment and possible screening in a research setting. 16,17 Most investigational protocols begin screening 10 years earlier than the age at which the youngest relative with pancreatic cancer received the diagnosis or at the age of 40-45 years, whichever occurs first.…”

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

“…To date, evidence on PDAC screening draws largely from single-arm trials in which magnetic resonance (MR) imaging, endoscopic ultrasonography (US), or computed tomography (CT) have been used in individuals with a known or suspected genetic predisposition (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). A small number of cancers have been detected relative to a large number of precursor lesions, the majority of which have been IPMNs (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). Most patients who underwent surgery in these trials did not have invasive cancer (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23).…”

“…However, our knowledge of the relationship between PDAC risk and screening benefits remains limited. Patient data from recent trials provide important insights (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)29), but restricted eligibility requirements, years of achievable follow-up, and high costs limit the extent to which even the best clinical trials can explore this relationship.…”

“…This refinement was needed only for localized cancers; screening was not expected to meaningfully affect the time of detection for regional and distant cancers. (12,15), and patients in whom advanced PDAC (or other advanced malignancy) was discovered at screening were also excluded (n = 4) (21,22). Notably, in our analysis, screening MR imaging was considered a strategy rather than an isolated test.…”

The importance of a well-structured pancreatic screening program for familial and hereditary pancreatic cancer

“…Most studies involved FPC families, while a few included carriers of a PDAC-associated gene defect [12,[14][15][16]. The screening protocols used in these studies varied widely, including MRI only, both MRI and endoscopic ultrasound (EUS), or MRI with optional EUS.…”