Best Practices to Screen for Pancreatic Cancer in High-Risk Individuals

pancreatic cancer
pancreatic cancer
A group of researchers released a review describing indications of pancreatic cancer (PC) in the screening of high risk individuals.

A group of researchers released a review describing indications of pancreatic cancer (PC) in the screening of high risk individuals. The article was published in Gastroenterology.

Authors wrote that when screening for PC, all potential risks and limitations of the process should be discussed with the patients prior to program initiation. The results of an abnormal screen should be evaluated by a team of multidisciplinary experts and discussed with patients. The authors also wrote that the preferred modality of screening for PC is a combination of magnetic resonance imaging (MRI) and performance of endoscopic ultrasound (EUS).

In addition, they noted that screening should be prioritized in high-risk patients, including those with at least 2 genetic relatives affected by PC, and those with genetic syndromes that increase risk for PC such as Peutz-Jeghers syndrome; hereditary pancreatitis; CDKN2A mutation or Lynch Syndrome with BRCA1, BRCA2, PALB2, and ATM mutations; and at least 1 relative affected by PC. The authors recommended that PC screening in high-risk individuals should start at 50 years of age, or 10 years prior to familial onset. If the individual is a carrier of CKDN2A and PRSS1 mutations with hereditary pancreatitis, authors recommended that screening begin at 40 years of age, and for those with Peutz-Jeghers syndrome, screening is recommended at 35 years of age.

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If no pancreatic lesions are detected during PC screening, the interval between subsequent screens should be set at 12 months. If lesions of intermediate risk are found, the authors recommended that EUS be performed within 3-6 months. For high risk lesions, they recommended that EUS evaluation should occur within 3 months if no surgical resection is planned. If a high-risk patient has newly-onset diabetes, authors recommended that additional diagnostic studies be performed.

Detectable pancreatic neoplasms can be resected: at stage 1 for pancreatic ductal adenocarcinoma, in high-risk precursor neoplasms such as intraductal papillary mucinous neoplasms, and in some enlarged pancreatic intraepithelial neoplasias. If the patient is likely to die from another disease, is not a candidate for pancreas resection, or is of average risk, the authors did not recommend PC screening.

Family members of patients with PC should consider genetic testing and counseling. The authors noted that a positive germline mutation can indicate risk for neoplastic progression and that screening for other cancers should be considered.

The authors concluded that randomized, prospective studies on how PC screening affects survival as well as which groups of patients should be defined as high-risk are still needed.

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Aslanian H R, Lee J H, and Canto M I. AGA clinical practice update on pancreas cancer screening in high risk individuals: expert review [available online May 19, 2020]. Gastroenterology. doi:10.1053/j.gastro.2020.03.088