Abstract
Pancreatic cancer has a high morbidity and mortality with 5-year survival rate below 5%. One of the major causes of this dismal survival rate is lack of tumor detection at an early stage. Identifying high-risk population can help in developing screening programs, thereby helping early diagnosis of neoplastic changes and impacting patient outcomes by allowing timely detection and intervention of pancreatic neoplasms. This chapter highlights the high-risk population for pancreatic cancer screening, modalities of screening, the risks and benefits of screening, and the endpoint of screening programs.
Similar content being viewed by others
References
Cancer, N.C.I.C.s.f.p. https://seer.cancer.gov/statfacts/html/pancreas
Hruban RH, et al. Update on familial pancreatic cancer. Adv Surg. 2010;44:293–311.
Kamisawa T, et al. Pancreatic cancer. Lancet. 2016;388(10039):73–85.
Canto MI, et al. International Cancer of the Pancreas Screening (CAPS) Consortium summit on the management of patients with increased risk for familial pancreatic cancer. Gut. 2013;62(3):339–47.
Goggins M, et al. Management of patients with increased risk for familial pancreatic cancer: updated recommendations from the International Cancer of the Pancreas Screening (CAPS) Consortium. Gut. 2020;69(1):7–17.
Syngal S, et al. ACG clinical guideline: genetic testing and management of hereditary gastrointestinal cancer syndromes. Am J Gastroenterol. 2015;110(2):223–62. quiz 263.
Aslanian HR, Lee JH, Canto MI. AGA clinical practice update on pancreas cancer screening in high-risk individuals: expert review. Gastroenterology. 2020;159(1):358–62.
Shi C, et al. Increased prevalence of precursor lesions in familial pancreatic cancer patients. Clin Cancer Res. 2009;15(24):7737–43.
Potjer TP, et al. Variation in precursor lesions of pancreatic cancer among high-risk groups. Clin Cancer Res. 2013;19(2):442–9.
Sohn TA, et al. Intraductal papillary mucinous neoplasms of the pancreas: an updated experience. Ann Surg. 2004;239(6):788–97. discussion 797–9.
Sawai Y, et al. Development of pancreatic cancers during long-term follow-up of side-branch intraductal papillary mucinous neoplasms. Endoscopy. 2010;42(12):1077–84.
Uehara H, et al. Development of ductal carcinoma of the pancreas during follow-up of branch duct intraductal papillary mucinous neoplasm of the pancreas. Gut. 2008;57(11):1561–5.
Canto MI, et al. Risk of neoplastic progression in individuals at high risk for pancreatic cancer undergoing long-term surveillance. Gastroenterology. 2018;155(3):740–751. e2.
Yu J, et al. Digital next-generation sequencing identifies low-abundance mutations in pancreatic juice samples collected from the duodenum of patients with pancreatic cancer and intraductal papillary mucinous neoplasms. Gut. 2017;66(9):1677–87.
Meckler KA, et al. Familial fibrocystic pancreatic atrophy with endocrine cell hyperplasia and pancreatic carcinoma. Am J Surg Pathol. 2001;25(8):1047–53.
Corral JE, et al. Diagnostic yield from screening asymptomatic individuals at high risk for pancreatic cancer: a meta-analysis of cohort studies. Clin Gastroenterol Hepatol. 2019;17(1):41–53.
Paiella S, et al. Screening/surveillance programs for pancreatic cancer in familial high-risk individuals: a systematic review and proportion meta-analysis of screening results. Pancreatology. 2018;18(4):420–8.
Henrikson NB, et al. Screening for pancreatic cancer: updated evidence report and systematic review for the US preventive services task force. JAMA. 2019;322(5):445–54.
Corral JE, et al. Cost-effectiveness of pancreatic cancer surveillance in high-risk individuals: an economic analysis. Pancreas. 2019;48(4):526–36.
Lowenfels AB, et al. Hereditary pancreatitis and the risk of pancreatic cancer. International Hereditary Pancreatitis Study Group. J Natl Cancer Inst. 1997;89(6):442–6.
Gruber SB, et al. Pathogenesis of adenocarcinoma in Peutz-Jeghers syndrome. Cancer Res. 1998;58(23):5267–70.
Giardiello FM, et al. Very high risk of cancer in familial Peutz-Jeghers syndrome. Gastroenterology. 2000;119(6):1447–53.
van Lier MG, et al. High cancer risk in Peutz-Jeghers syndrome: a systematic review and surveillance recommendations. Am J Gastroenterol. 2010;105(6):1258–64. author reply 1265.
Hartge P, et al. The prevalence of common BRCA1 and BRCA2 mutations among Ashkenazi Jews. Am J Hum Genet. 1999;64(4):963–70.
van Asperen CJ, et al. Cancer risks in BRCA2 families: estimates for sites other than breast and ovary. J Med Genet. 2005;42(9):711–9.
Yang X, et al. Cancer risks associated with germline PALB2 pathogenic variants: an international study of 524 families. J Clin Oncol. 2020;38(7):674–85.
Lynch HT, et al. Phenotypic variation in eight extended CDKN2A germline mutation familial atypical multiple mole melanoma-pancreatic carcinoma-prone families: the familial atypical mole melanoma-pancreatic carcinoma syndrome. Cancer. 2002;94(1):84–96.
Lynch HT, et al. Pancreatic cancer and the FAMMM syndrome. Familial Cancer. 2008;7(1):103–12.
Vasen HF, et al. Risk of developing pancreatic cancer in families with familial atypical multiple mole melanoma associated with a specific 19 deletion of p16 (p16-Leiden). Int J Cancer. 2000;87(6):809–11.
de Snoo FA, et al. Increased risk of cancer other than melanoma in CDKN2A founder mutation (p16-Leiden)-positive melanoma families. Clin Cancer Res. 2008;14(21):7151–7.
Win AK, et al. Colorectal and other cancer risks for carriers and noncarriers from families with a DNA mismatch repair gene mutation: a prospective cohort study. J Clin Oncol. 2012;30(9):958–64.
Geary J, et al. Gene-related cancer spectrum in families with hereditary non-polyposis colorectal cancer (HNPCC). Familial Cancer. 2008;7(2):163–72.
Kastrinos F, et al. Risk of pancreatic cancer in families with Lynch syndrome. JAMA. 2009;302(16):1790–5.
Swift M, et al. Incidence of cancer in 161 families affected by ataxia-telangiectasia. N Engl J Med. 1991;325(26):1831–6.
Roberts NJ, et al. ATM mutations in patients with hereditary pancreatic cancer. Cancer Discov. 2012;2(1):41–6.
Grover S, Syngal S. Hereditary pancreatic cancer. Gastroenterology. 2010;139(4):1076–80, 1080.e1–2
Klein AP, et al. Prospective risk of pancreatic cancer in familial pancreatic cancer kindreds. Cancer Res. 2004;64(7):2634–8.
Wang W, et al. PancPRO: risk assessment for individuals with a family history of pancreatic cancer. J Clin Oncol. 2007;25(11):1417–22.
Chaffee KG, et al. Prevalence of germ-line mutations in cancer genes among pancreatic cancer patients with a positive family history. Genet Med. 2018;20(1):119–27.
Wood LD, Yurgelun MB, Goggins MG. Genetics of familial and sporadic pancreatic cancer. Gastroenterology. 2019;156(7):2041–55.
Hu C, et al. Association between inherited germline mutations in cancer predisposition genes and risk of pancreatic cancer. JAMA. 2018;319(23):2401–9.
Canto MI, et al. Frequent detection of pancreatic lesions in asymptomatic high-risk individuals. Gastroenterology. 2012;142(4):796–804; quiz e14–5.
Ludwig E, et al. Feasibility and yield of screening in relatives from familial pancreatic cancer families. Am J Gastroenterol. 2011;106(5):946–54.
Harinck F, et al. A multicentre comparative prospective blinded analysis of EUS and MRI for screening of pancreatic cancer in high-risk individuals. Gut. 2016;65(9):1505–13.
Topazian M, et al. Interobserver agreement for EUS findings in familial pancreatic-cancer kindreds. Gastrointest Endosc. 2007;66(1):62–7.
Brugge WR, et al. Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study. Gastroenterology. 2004;126(5):1330–6.
Chari ST, et al. Probability of pancreatic cancer following diabetes: a population-based study. Gastroenterology. 2005;129(2):504–11.
Chari ST, et al. Pancreatic cancer-associated diabetes mellitus: prevalence and temporal association with diagnosis of cancer. Gastroenterology. 2008;134(1):95–101.
Sharma A, et al. Model to determine risk of pancreatic cancer in patients with new-onset diabetes. Gastroenterology. 2018;155(3):730–739.e3.
(v1.2020), N.C.C.N.N.g.
Stoffel EM, et al. Evaluating susceptibility to pancreatic cancer: ASCO provisional clinical opinion. J Clin Oncol. 2019;37(2):153–64.
Shelton C, Solomon S, LaRusch J, Whitcomb DC. PRSS1-related hereditary pancreatitis. 2012 Mar 1 [updated 2019 Apr 25]. In: Adam MP, Ardinger HH, Pagon RA, Wallace SE, Bean LJH, Mirzaa G, Amemiya A, editors. GeneReviews® [Internet]. Seattle (WA): University of Washington, Seattle; 1993–2021.
Abe T, et al. Deleterious germline mutations are a risk factor for neoplastic progression among high-risk individuals undergoing pancreatic surveillance. J Clin Oncol. 2019;37(13):1070–80.
Scheiman JM, Hwang JH, Moayyedi P. American gastroenterological association technical review on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology. 2015;148(4):824–48. e22
Zerboni G, et al. Systematic review and meta-analysis: prevalence of incidentally detected pancreatic cystic lesions in asymptomatic individuals. Pancreatology. 2019;19(1):2–9.
Tanaka M, et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology. 2012;12(3):183–97.
Crippa S, et al. Low progression of intraductal papillary mucinous neoplasms with worrisome features and high-risk stigmata undergoing non-operative management: a mid-term follow-up analysis. Gut. 2017;66(3):495–506.
Matthaei H, et al. Presence of pancreatic intraepithelial neoplasia in the pancreatic transection margin does not influence outcome in patients with R0 resected pancreatic cancer. Ann Surg Oncol. 2011;18(12):3493–9.
Brune K, et al. Multifocal neoplastic precursor lesions associated with lobular atrophy of the pancreas in patients having a strong family history of pancreatic cancer. Am J Surg Pathol. 2006;30(9):1067–76.
Canto MI, et al. Surgical outcomes after pancreatic resection of screening-detected lesions in individuals at high risk for developing pancreatic cancer. J Gastrointest Surg. 2020;24(5):1101–10.
Rulyak SJ, et al. Risk factors for the development of pancreatic cancer in familial pancreatic cancer kindreds. Gastroenterology. 2003;124(5):1292–9.
Li D, et al. Body mass index and risk, age of onset, and survival in patients with pancreatic cancer. JAMA. 2009;301(24):2553–62.
Gapstur SM, et al. Association of alcohol intake with pancreatic cancer mortality in never smokers. Arch Intern Med. 2011;171(5):444–51.
Ansary-Moghaddam A, et al. The effect of modifiable risk factors on pancreatic cancer mortality in populations of the Asia-Pacific region. Cancer Epidemiol Biomark Prev. 2006;15(12):2435–40.
Sah RP, et al. New insights into pancreatic cancer-induced paraneoplastic diabetes. Nat Rev Gastroenterol Hepatol. 2013;10(7):423–33.
Huxley R, et al. Type-II diabetes and pancreatic cancer: a meta-analysis of 36 studies. Br J Cancer. 2005;92(11):2076–83.
Swanson RS, et al. The 90-day mortality after pancreatectomy for cancer is double the 30-day mortality: more than 20,000 resections from the national cancer data base. Ann Surg Oncol. 2014;21(13):4059–67.
Liu J, et al. Combination of plasma microRNAs with serum CA19-9 for early detection of pancreatic cancer. Int J Cancer. 2012;131(3):683–91.
Kanda M, et al. Mutant GNAS detected in duodenal collections of secretin-stimulated pancreatic juice indicates the presence or emergence of pancreatic cysts. Gut. 2013;62(7):1024–33.
Kanda M, et al. Mutant TP53 in duodenal samples of pancreatic juice from patients with pancreatic cancer or high-grade dysplasia. Clin Gastroenterol Hepatol. 2013;11(6):719–30.e5.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2021 Springer Nature Switzerland AG
About this entry
Cite this entry
Kothari, S., Kaul, V., Kothari, T.H. (2021). Reducing the Risk of and Screening for Pancreatic Cancer. In: Doria, C., Rogart, J.N. (eds) Hepato-Pancreato-Biliary Malignancies. Springer, Cham. https://doi.org/10.1007/978-3-030-37482-2_35-1
Download citation
DOI: https://doi.org/10.1007/978-3-030-37482-2_35-1
Received:
Accepted:
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-37482-2
Online ISBN: 978-3-030-37482-2
eBook Packages: Springer Reference MedicineReference Module Medicine