The impact of pancreatic cancer screening on life expectancy: A systematic review of modeling studies

Koopmann, Brechtje D M; Omidvari, Amir‐Houshang; Lansdorp–Vogelaar, Iris; Cahen, Djuna L.; Bruno, Marco J.; Kok, Inge M.C.M. de

doi:10.1002/ijc.34379

Cited by 5 publications

(3 citation statements)

References 36 publications

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“… 18 Therefore, pancreatic cancer is not included for screening in the general population in most countries. 19 - 21 …”

Section: The Challenge With Early Cancer Detection and Early Cancer S...mentioning

confidence: 99%

“…18 Therefore, pancreatic cancer is not included for screening in the general population in most countries. [19][20][21] The Challenge With Cancer Screening For screening of a disease to be effective, the disease should be diagnosed at an early, asymptomatic stage when cure is possible, but for pancreatic cancer this is a rare event in clinical practice. 22 The prerequisite for any screening program, 9,10 is having a patient population with a high enough prevalence of the disease that 1 is looking for, as even a good test will suffer from a low prevalence and result in low yield, ie low positive predictive value.…”

Section: The Challenge With Early Cancer Detection and Early Cancer S...mentioning

confidence: 99%

“…7 The consensus is that widespread population-based screening for pancreatic cancer in the general population is neither practicable nor indicated in most countries. 20,21,23,24 One report concluded that screening for pancreatic cancer would not improve disease-specific survival based on the rapid progression of the disease; the overall benefits was estimated to be small at best; and, that screening would be associated by a modest risk of harms. 25,26 Consequently, screening is not supported in most guidelines.…”

Section: The Challenge With Cancer Screeningmentioning

confidence: 99%

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Early Diagnosis of Pancreatic Cancer: Clinical Premonitions, Timely Precursor Detection and Increased Curative-Intent Surgery

et al. 2023

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Background The overall poor prognosis in pancreatic cancer is related to late clinical detection. Early diagnosis remains a considerable challenge in pancreatic cancer. Unfortunately, the onset of clinical symptoms in patients usually indicate advanced disease or presence of metastasis. Analysis and Results Currently, there are no designated diagnostic or screening tests for pancreatic cancer in clinical use. Thus, identifying risk groups, preclinical risk factors or surveillance strategies to facilitate early detection is a target for ongoing research. Hereditary genetic syndromes are a obvious, but small group at risk, and warrants close surveillance as suggested by society guidelines. Screening for pancreatic cancer in asymptomatic individuals is currently associated with the risk of false positive tests and, thus, risk of harms that outweigh benefits. The promise of cancer biomarkers and use of ‘omics’ technology (genomic, transcriptomics, metabolomics etc.) has yet to see a clinical breakthrough. Several proposed biomarker studies for early cancer detection lack external validation or, when externally validated, have shown considerably lower accuracy than in the original data. Biopsies or tissues are often taken at the time of diagnosis in research studies, hence invalidating the value of a time-dependent lag of the biomarker to detect a pre-clinical, asymptomatic yet operable cancer. New technologies will be essential for early diagnosis, with emerging data from image-based radiomics approaches, artificial intelligence and machine learning suggesting avenues for improved detection. Conclusions Early detection may come from analytics of various body fluids (eg ‘liquid biopsies’ from blood or urine). In this review we present some the technological platforms that are explored for their ability to detect pancreatic cancer, some of which may eventually change the prospects and outcomes of patients with pancreatic cancer.

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“… 18 Therefore, pancreatic cancer is not included for screening in the general population in most countries. 19 - 21 …”

Section: The Challenge With Early Cancer Detection and Early Cancer S...mentioning

confidence: 99%

Section: The Challenge With Early Cancer Detection and Early Cancer S...mentioning

confidence: 99%

Section: The Challenge With Cancer Screeningmentioning

confidence: 99%

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Early Diagnosis of Pancreatic Cancer: Clinical Premonitions, Timely Precursor Detection and Increased Curative-Intent Surgery

et al. 2023

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The impact of pancreatic cancer screening on life expectancy: A systematic review of modeling studies

Koopmann

Omidvari

Lansdorp–Vogelaar

et al. 2022

Intl Journal of Cancer

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Evidence supporting the effectiveness of pancreatic cancer (PC) screening is scant.Most clinical studies concern small populations with short follow-up durations. Mathematical models are useful to estimate long-term effects of PC screening using shortterm indicators. This systematic review aims to evaluate the impact of PC screening on life expectancy (LE) in model-based studies. Therefore, we searched four databases (Embase, Medline, Web-of-science, Cochrane) until 30 May 2022 to identify model-based studies evaluating the impact of PC screening on LE in different risk populations. Two authors independently screened identified papers, extracted data and assessed the methodological quality of studies. A descriptive analysis was performed and the impact of screening strategies on LE of different risk groups was reported. Our search resulted in 419 studies, of which eight met the eligibility criteria (mathematical model, PC screening, LE). Reported relative risks (RR) for PC varied from 1 to 70. In higher risk individuals (RR > 5), annual screening (by imaging with 56% sensitivity for HGD/early stage PC) predicted to increase LE of screened individuals by 20 to 260 days. In the general population, one-time PC screening was estimated to decrease LE (2-110 days), depending on the test characteristics and treatment mortality risk. In conclusion, although the models use different and sometimes outdated or unrealistic assumptions, it seems that PC screening in high-risk populations improves LE, and that this gain increases with a higher PC risk. Updated model studies, with data from large clinical trials are necessary to predict the longterm effect of PC screening more accurately.

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Small cyst size and lack of growth as negative predictors of malignant transformation in low‐risk intraductal papillary mucinous neoplasms of the pancreas: A systematic review and meta‐analysis

Meziani,

Sprij,

Fuhler

et al. 2024

UEG Journal

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Background and AimFor branch‐duct intraductal papillary mucinous neoplasms (BD‐IPMNs) without worrisome features (WFs) or high‐risk stigmata (HRS), current guidelines recommend surveillance. However, these intraductal papillary mucinous neoplasm (IPMNs), especially the small and stable‐sized ones, carry a low risk of malignant transformation. Our aim was to assess whether small cyst size and absence of rapid growth provide reassurance against the development of WFs/HRS and malignancy (high‐grade dysplasia (HGD) or pancreatic cancer (PC)).MethodsPubMed/Medline, Embase, the Cochrane Library and the Web of Science Core Collection were systematically searched from inception to May 2023 to identify studies investigating surveillance outcomes of low‐risk BD‐IPMNs. Studies assessing baseline cyst size and/or growth in relation to WFs/HRS and/or HGD/PC were included. The Newcastle‐Ottawa scale tool was used to assess study quality.ResultsOf the 1937 identified manuscripts, 21 studies were eligible for inclusion. The quality of these studies was considered reasonable. A negative association between cyst size and WFs/HRS development was found in 11 out of 13 relevant studies, but only one out of nine studies reported a negative association between size and malignancy. Regarding cyst growth, four out of six studies described a negative association with the development of WFs/HRS, and all six reported a negative association with malignancy. The pooled relative risk (RR) of developing WFs/HRS or malignancy for cysts ≤15 mm was 0.37 (95% CI 0.25–0.57) and the RR of developing malignancy for cyst growth <2–2.5 mm/year was 0.04 (95% CI 0.02–0.09)).ConclusionThis systematic review and meta‐analysis shows that small and stable‐sized low‐risk BD‐IPMNs are associated with a markedly low progression rate, with stable cyst size being the most reassuring feature. Because of substantial heterogeneity in definitions and reported outcome measures, prospective studies are needed to confirm that surveillance of small and stable sized cyst can be de‐intensified or even discontinued.

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The impact of pancreatic cancer screening on life expectancy: A systematic review of modeling studies

Cited by 5 publications

References 36 publications

Early Diagnosis of Pancreatic Cancer: Clinical Premonitions, Timely Precursor Detection and Increased Curative-Intent Surgery

Early Diagnosis of Pancreatic Cancer: Clinical Premonitions, Timely Precursor Detection and Increased Curative-Intent Surgery

The impact of pancreatic cancer screening on life expectancy: A systematic review of modeling studies

Small cyst size and lack of growth as negative predictors of malignant transformation in low‐risk intraductal papillary mucinous neoplasms of the pancreas: A systematic review and meta‐analysis

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