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

Expert Commentary

Pancreatic cancer screening is a relatively new and evolving field of medicine. The current guidelines of the US Preventive Services Task Force recommend against a routine screening of individuals for pancreatic cancer. However, high-risk cohorts of patients for pancreatic cancer, such as patients with chronic pancreatitis, individuals with a family history of pancreatic cancer, hereditary pancreatitis, Peutz-Jeghers syndrome, cystic fibrosis or FAMMM, may benefit from early screening with regards to clinical outcome and cost-effectiveness.

Currently, the clinical role of pancreatic screening for moderate-risk patients, such as patients with diabetes mellitus, obesity, hereditary breast or ovarian cancer, or smokers, is less clear and warrants further studies to justify screening for these patient cohorts.

A reasonable practical approach would be to screen high-risk patients using EUS as a first-line screening method and, if applicable, also in combination with CT imaging. If a mass is detected on EUS, a FNA should be performed in order to determine its cytology. ERCP can be used in addition in order to clarify the diagnostic findings. If the lesions are too small to biopsy, a repeat imaging study should be performed within 3 months. Once pancreatic cancer is confirmed by histology, a staging effort should be initiated, using CT, MRI and EUS modalities to determine its resectability. Once resectability has been confirmed, a surgical evaluation should be performed by an expert pancreatic surgeon after considering all risks, benefits and alternatives involved.

Currently, we are only able to screen approximately 10% of individuals who will develop pancreatic cancer, and EUS as an initial screening method is both invasive and operator-dependent.

For screening to detect cancer at a biological stage that would be amenable for cure by total pancreatectomy, diagnostic modalities with a very high sensitivity and specificity would be required.

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