Screening to Detect Precursor Lesions of Pancreatic Adenocarcinoma in High-risk Individuals: A Single-center Experience

Abstract

Objective of the workPancreatic cancer (PC) is a deadly disease that is most commonly diagnosed at an incurable stage. Early diagnosis is the most important factor for improving prognosis. Evidence is beginning to accumulate that screening and surveillance may lead to the early detection of precursor lesions and/or pancreatic cancer in asymptomatic individuals. Proper screening methods and identification of such precursor lesions may enable effective pre-emptive interventions to prevent further fatalities. The primary objective of this project was to examine the feasibility of identifying precursor or early cancerous lesions in high-risk individuals by endoscopic ultrasound (EUS) screening to prevent the deaths from pancreatic cancer.Research aimPancreatic cancer screening guidelines, based on consensus opinions, have been applied in various tertiary centers around the world; however, evidence for effectiveness is lacking. At Rambam Health Care Campus, we have established a cohort of high-risk individuals, and we report our local 10-year experience results of screening for pancreatic cancer.MethodsBetween 2008 and 2018, a cohort of 123 asymptomatic high-risk individuals came for annual/biannual EUS screening for pancreatic cancer. Retrospective and prospectively collected data were obtained, analyzed, and compared on the basis of several variables. These variables include age at beginning of screening, gender, smoking, obesity, diabetes, and presence of tumor markers, as well as the patients’ personal and family history of cancers. Findings on each EUS are described.ResultsThree patients out of 123 underwent potentially life-saving surgery as a result of this screening program. All of these three had only one first-degree relative (FDR) with pancreatic cancer at the time of their first screenings, but two eventually had a second FDR with PC. Findings from 296 EUS exams regarding smoking, obesity, and other risk factors are presented. Minor, possibly trivial, EUS findings are found to be common. Detection of precursor pancreatic lesions is feasible with EUS screenings.ConclusionsAdherence was an important limiting factor in screening. Better stratification of patients according to specific risk factors, including thorough genetics and family history, may direct when and how to initiate screening. International collaborations, such as the International Cancer of Pancreas Screening (CAPS) Consortium, of which Rambam is a collaborating partner, are needed to collate evidence for impact of screening to prevent pancreatic cancer morbidity and mortality, and are essential to achieve proof of concept. Different countries with varying health-care systems and budgets can find variance of appropriateness of screening procedures.

Aspects and outcomes of surveillance for individuals at high-risk of pancreatic cancer

“…These lesions are characterized by their cystic nature, mucin secretion and are less common than PanINs [ 29 ]. Studies on HRIs indicate that cystic lesions, particularly branch-duct (BD) type IPMN, are the most commonly diagnosed abnormalities during pancreatic cancer surveillance [ 30 – 37 ]. This occurrence is not unusual, considering the high prevalence of IPMNs, which can reach up to 11.3–25% among the general population aged ≥ 55 years and increases with age [ 38 , 39 ].…”

Pancreatic Cancer Screening for At-Risk Individuals (Pancreas Scan Study): Yield, Harms, and Outcomes From a Prospective Multicenter Study

“…No complications were noted in the 1 patient in our study who underwent surgery. Six studies reported adverse events from pancreatic surgery in patients undergoing screening, with a pooled event rate of 19% (95% CI 7.4%-43.4%) (24,25,27,30,32,33).…”

Avances en el diagnóstico por ultrasonido endoscópico (USE)

“…La cohorte con Peutz-Jegher mostró un mayor riesgo (10%). El segundo estudio es israelí y en él evaluaron la factibilidad del escrutinio con ultrasonido endoscópico de los pacientes de alto riesgo para cáncer de páncreas 2 . Se incluyeron 123 pacientes evaluados entre 2008 y 2018 de forma anual o bienal.…”