Pancreatic cancer screening appears to be safe and effective for certain patients with high-risk indications due to genetic susceptibility, according to a prospective multicenter study presented at the annual meeting of the American College of Gastroenterology.
Screening in high-risk patients detected high-risk lesions in 0.8% of patients, which was lower than the typical range found in the literature, at 3%, said Andy Silva-Santisteban, MD, a research fellow at Beth Israel Deaconess Medical Center at Harvard Medical School in Boston.
Pancreatic cancer is the third leading cause of cancer death in the U.S., which is estimated to become the second leading cause by 2030. About 15%-20% of patients are candidates for surgical resection at the time of diagnosis, with survival rates below 10%.
"These statistics have led pancreatic cancer screening to be studied with the goal of detecting earlier stages of the disease to improve survival," Silva-Santisteban said. "However, pancreatic cancer screening is not recommended for the general population."
Pancreatic cancer screening is recommended for patients with increased risk due to genetic susceptibility, yet recent studies have found that screening studies face limitations from factors like small sample sizes, single-center focus, retrospective nature, nonconsecutive accrual of patients, varied inclusion criteria, and use of nonstandardized screening protocols.
To overcome these limitations, Silva-Santisteban and colleagues conducted a prospective multicenter study of pancreatic cancer screening in consecutive high-risk patients at five centers in the United States between 2020 and 2022, also called the Pancreas Scan Study. Silva-Santisteban presented results from the first round of enrollment, which was awarded the Outstanding Research Award in the Biliary/Pancreas Category for Trainee.
The research team evaluated the yield (low-, moderate-, and high-risk pancreatic pathology), safety, and outcomes of screening. Low-risk pancreas pathology was categorized as fatty pancreas and chronic pancreatitis-like changes. Intermediate-risk was categorized as branch duct–intraductal papillary mucinous neoplasm or neuroendocrine tumor under 2 cm. High-risk was categorized as main duct–intraductal papillary mucinous neoplasm (MD-IPMN), pancreatic intraepithelial neoplasia grade III (PanIN-III)/dysplasia, neuroendocrine tumor over 2 cm, or pancreatic cancer.
Patients were included if they were 18 years or older and had at least one of the following: BRCA1, BRCA2, or PALB2 plus a family history of pancreatic cancer; Lynch syndrome plus a family history of pancreatic cancer; Peutz-Jeghers syndrome; familial atypical multiple mole melanoma (FAMMM); ataxia telangiectasia mutated plus family history of pancreatic cancer; hereditary pancreatitis; or familial pancreatic cancer (FPC) syndrome.
Screening was performed annually with either endoscopic ultrasound (EUS) or magnetic resonance cholangiopancreatography (MRCP). Fasting blood sugar was recorded annually to screen for new-onset diabetes.
Among 252 patients, 208 underwent EUS and 44 underwent MRCP. At the time of enrollment, 38.5% underwent their first screening, and 61.5% had a prior screening. The average age was 60, 69% were women, and 79% were White.
The most common indication was a BRCA1 or BRCA2 pathogenic variant in 93 patients (or 36.5%), followed by FPC syndrome in 80 patients (or 31.7%).
Low-risk pancreas pathology was noted in 23.4% of patients, with 17.5% having chronic pancreatitis-like changes. Intermediate risk was found in 31.7%, with nearly all detected as branch-duct IPMNs without worrisome features, Silva-Santisteban said.
Two patients (.8%) fell into the high-risk category with pancreatic adenocarcinoma. Both were positive for BRCA2 mutation and family history of pancreatic cancer.
In the first patient, who was compliant with screening, EUS showed a 3-cm adenocarcinoma (T2N1M0 stage IIB). The patient underwent neoadjuvant chemotherapy, followed by total pancreatectomy, and is currently in cancer remission. No complications from surgery were noted.
In the second patient, who was not compliant with screening and was lost to follow-up for 6 years, EUS showed a 2.5-cm adenocarcinoma and four metastatic lesions in the liver (T2N1M1 stage IV). The patient underwent palliative chemotherapy.
EUS was more likely to identify chronic pancreatitis-like changes, but MRCP was more likely to identify BD-IPMN. The two patients with pancreatic adenocarcinoma were identified with EUS. However, there wasn't a significant difference between EUS and MRCP in identifying high-risk lesions.
In patients undergoing screening, new-onset prediabetes was noted in 18.2%, and new-onset diabetes was noted in 1.7%. However, there was no association between abnormal blood sugar and pancreas pathology.
Twelve patients (4.8%) underwent further pancreatic evaluation because of screening findings. None of the patients underwent low-yield pancreatic surgery, which was lower than reported in the literature, at 2.8%. Overall, there were no complications as a direct result of screening with EUS or MRI.
"Patients should be carefully counseled regarding benefits and harms from pancreatic cancer screening," Silva-Santisteban said. "When feasible, such screening should be performed within the confines of a research study so more precise estimates of screening outcomes can be determined."
The study funding was not disclosed. One author reported a consultant relationship with Pentax Medical, and the other authors indicated no relevant financial relationships.
This article originally appeared on MDedge.com, part of the Medscape Professional Network.
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Cite this: Pancreatic Cancer Screening Appears Safe, Effective for High-Risk Patients - Medscape - Oct 26, 2022.