What are international CAPS consortium guidelines for pancreatic cancer screening?

Updated: Jan 10, 2020
  • Author: Tomislav Dragovich, MD, PhD; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
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Answer

The International CAPS Consortium, a panel of 49 multidisciplinary experts, released consensus guidelines for pancreatic cancer screening in 2012 and updated them in 2020. [91, 92] The consortium recommends screening for stage I pancreatic cancer and pancreatic cancer precursor lesions with high-grade dysplasia in the following high-risk groups [92] :

  • All patients with Peutz-Jeghers syndrome (carriers of a germline LKB1/STK11 gene mutation)
  • All carriers of a germline CDKN2A mutation
  •  Carriers of a germline BRCA2, BRCA1, PALB2, ATM, MLH1, MSH2, or MSH6 gene mutation with at least one affected first-degree blood relative
  • Individuals who have at least one first-degree relative with pancreatic cancer who in turn also has a first-degree relative with pancreatic cancer (familial pancreatic cancer kindred)

The recommended age at which to start surveillance varied by gene mutation status and family history, as follows [92] :

  • Familial pancreatic cancer kindred (without a known germline mutation) -  Start at age 50 or 55, or 10 years younger than the youngest affected blood relative
  • CDKN2A or Peutz-Jegher syndrome - Start at age 40
  • BRCA2,ATM, PALB2 BRCA1, MLH1/MSH2 - Start at age 45 or 50, or 10 years younger than the youngest affected blood relative

Recommended screening techniques are as follows [92] :

  • At baseline - Magnetic resonance imaging (MRI)/magnetic resonance cholangiopancreatography (MRCP) plus endoscopic ultrasound (EUS) plus fasting blood glucose and/or HbA1c
  • During followup - Alternate MRI/MRCP and EUS; routinely test fasting blood glucose and/or HbA1c
  • As indicated -  Serum CA 19–9, if concerning features on imaging; EUS-FNA only for solid lesions of ≥5 mm, cystic lesions with worrisome features, or asymptomatic main pancreatic duct (MPD) strictures (with or without mass); CT only for solid lesions, regardless of size, or asymptomatic MPD strictures of unknown etiology (without mass)

The consortium recommends a screening interval of every 12 months in patients with no abnormalities, or only non-concerning abnormalities (eg, pancreatic cysts without worrisome features), and every 3 or 6 months in patients with abnormalities that are not suspicious for malignancy but are concerning; immediate surgical resection is indicated for abnormalities suspicious for malignancy. [92]


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