Improving pancreatic cancer screening will require such steps as adhering to guidelines to perform germline testing and standardizing data collection among patients, according to a study in Gastroenterology.
The Pancreatic Cancer Early Detection (PRECEDE) Consortium reviewed current pancreatic cancer screening practices and recommended an approach to overcome the various challenges associated with improving screening efficacy.
The consortium recommends the following:
- Adherence to guidelines to perform germline testing in all pancreatic cancer patients and individuals with a family history of pancreatic cancer using a minimum set of genes that are part of consensus pancreas screening guidelines
- Standardization of data collection for patients with pancreatic cancer and high-risk individuals (HRI) across relevant domains, with use of uniform templates and instruments when possible, including cancer family history (3-generation pedigree), modifiable risk factors, and magnetic resonance imaging and endoscopic ultrasound (EUS) variables
- Creation of centralized or broadly accessible data and image repositories.
Developing and standardizing methods for conducting and reporting testing is important for improving pancreatic cancer detection, noted the consortium investigators. “This step is critical to move toward eventual reporting of outcomes at a large enough scale to demonstrate screening efficacy,” the group stated. “There is a need to optimize screening algorithms and collection of longitudinal demographic, genetic, imaging, and biomarker data over an extended period of time.”
Obtaining a family history of cancer is a key part of risk stratification and clinical management for families at risk for pancreatic cancer. A 3-generation pedigree that includes information about primary cancer sites and ages at diagnosis for all relatives with a history of cancer is the best-practice approach in a high-risk clinical setting, according to the investigators. Pedigree documentation should also include genetic testing results and the specific genes analyzed for family members.
Standard documentation of known pancreatic cancer risk factors should be part of high-risk care, according to the group. In addition, the consortium noted that EUS images are rarely recorded in a high-resolution manner and EUS abnormalities need to be acquired and reported in a standardized method.
A first step in standardizing EUS imaging is defining a complete examination with landmarks to assess imaging adequacy. “Reporting of landmarks should be analogous to now-established colonoscopy standards, and recording of these landmarks should be mandatory,” stated the group.
“We are at an inflection point in the history of pancreatic cancer screening,” the research group commented. “There is an increasing opportunity to decrease mortality of pancreatic cancer through early detection, and the growing number of patients who will be eligible for screening highlight the importance of well-organized, large scale, long-term, longitudinal follow up studies of a population with sufficiently high risk for cancer that screening impact can be adequately assessed,” they concluded.
Gonda TA, Everett JN, Wallace M, Simeone DM. Recommendations for a more organized and effective approach to the early detection of pancreatic cancer from the PRECEDE (Pancreatic Cancer Early Detection) Consortium. Gastroenterol. Published online August 26, 2021. doi: 10.1053/j.gastro.2021.08.036