Pancreatic Cancer Screening: State of the Art

Christian Gemmel; Axel Eickhoff; Lars Helmstädter; Jürgen F Riemann

Disclosures

Expert Rev Gastroenterol Hepatol. 2009;3(1):89-96. 

In This Article

Abstract and Introduction

Abstract

Pancreatic cancer is a devastating disease with a median survival of approximately 6 months after diagnosis. Many factors are associated with a worse outcome; examples include late diagnosis, low resection rate, aggressive tumor behavior and a lack of an effective chemotherapy regimen. Owing to the low prevalence of pancreatic cancer relative to the diagnostic accuracy of present detection methods and the absence of promising treatment modalities, even in early stages, it is currently neither advisable nor cost effective to screen the general population. Efforts are focused on early screening of selected high-risk-cohorts, who account for approximately 10% of patients with pancreatic cancer. These include patients with chronic pancreatitis, individuals with a family history of pancreatic cancer, patients with hereditary pancreatitis, Peutz-Jeghers syndrome, cystic fibrosis or familial atypical multiple mole melanoma. At present, a multimodal-screening approach of endoscopic ultrasound, computed tomography and endoscopic retrograde cholangiopancreatography appears to be the most effective method to screen for pancreatic cancer in high-risk patients. Continued efforts are needed to elucidate effective testing to identify patients with nonhereditary risk factors who will benefit from screening protocols. A combined approach of serum markers, genetic markers and specific imaging studies may prove to be the future of pancreatic screening.

Introduction

Based on estimates from the American Cancer Society, the number of Americans newly diagnosed with pancreatic cancer will be 37,680 in the year 2008, with 34,290 patients dying from this disease.[1] During the last 40 years, its overall incidence has steadily increased, according to data from the National Cancer Institute in Bethesda, MD, USA.[2] Worldwide, the estimates were projected to be 216,400 new cases and 213,500 deaths in the year 2000.[3]

The median survival for all patients with pancreatic cancer is approximately 6 months[4] and the 5-year survival rate - estimated by the Surveillance Epidemiology and End Results Program - is 4%, which is the lowest among all types of cancer.[5,6]

The diagnosis of pancreatic cancer continues to be made very late with regards to the progression of the disease, mainly owing to the fact that common presenting symptoms, such as pain, jaundice or weight loss, occur relatively late, often when the disease is already metastatic.[7]

Therefore, this raises the question of whether screening for pancreatic cancer at an early phase when patients do not have any symptoms can be a promising strategy in terms of survival and costs. Although this strategy has been successful for the early detection of breast, colon, cervical and prostate cancer, it has not been possible to validate this approach with regards to pancreatic cancer. The current guidelines of the US Preventive Services Task Force underline the fact that[8]:

"... there is no evidence that screening for pancreatic cancer is effective in reducing mortality and the harms of screening for pancreatic cancer exceed any potential benefits."

However, this recommendation only includes studies up to the year 2001 and, unfortunately, newer studies are not included in the current guidelines.

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