Pancreatic Cancer Screening: Who Should We Consider?
Vanessa M. Shami, MD, FASGE, reviewing Aslanian HR, et al. Gastroenterology 2020 May 19.
The incidence of pancreatic cancer continues to grow, and despite advances in oncologic treatment, the mortality rate continues to be high. The goal of screening is to identify patients with precursor lesions or very early cancers who can undergo potentially curative resection. It is not feasible to screen the entire population, hence the importance of identifying high-risk groups. This clinical practice update from the American Gastroenterological Association identifies these high-risk groups and provides recommendations on the modality and frequency with which to screen these patients.
- Limitations and potential risks of screening should be discussed with the patient prior to initiating screening.
- The highest risk populations that should be considered for screening include patients with Peutz-Jeghers syndrome (STK11/LKB1 genes; relative risk [RR], 132), hereditary pancreatitis (PRSS1 gene; RR, 53), familial atypical multiple mole melanoma syndrome (CDKN2A gene; RR, 13-39), and familial pancreatic cancer (RR, 4-9.3).
- Screening should be offered to patients with at least one first-degree relative with pancreatic cancer and one of the following mutations: Lynch syndrome (MLH1, MSH2, MSH6 genes; RR, 8.6-11), BRCA1 (RR, 2.26), BRCA2 (RR, 3.5-6.2), PALB2, and/or ATM (RR, 3.92).
- Genetic counseling and testing should be considered in individuals with relatives who have familial pancreatic cancer.
- MRI in combination with EUS is the recommended preferred screening modality.
- Recommended onset of screening:
- Age 50 or 10 years younger than the initial age of familial onset.
- Age 40 in CKDN2A and PRSS1 mutation carriers.
- Age 35 in patients with Peutz-Jeghers syndrome.
- Screening/surveillance intervals:
- Twelve months if no lesions.
- Six to 12 months for low-risk lesions (as determined by multidisciplinary teams).
- Three to 6 months for high-risk lesions if surgery is not performed.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
Aslanian HR, Lee JH, Canto MI. AGA clinical practice update on pancreas cancer screening in high risk individuals: expert review. Gastroenterology 2020 May 19. (Epub ahead of print) (https://doi.org/10.1053/j.gastro.2020.03.088)