Abstract
Screening for pancreatic cancer (PC) in high-risk groups aimed to detect early cancers is currently done only in the research setting, and data on psychological outcomes of screening in these populations is scarce. To determine the psychological impact of a national Australian pancreatic screening program, a prospective study was conducted using validated psychological measures: impact of events scale (IES), psychological consequences questionnaire (PCQ) and the cancer worry scale. Measures were administered at baseline, 1-month and at 1-year post-enrolment and correlations with abnormal endoscopic ultrasound (EUS) results were calculated. Over a 6-year period, 102 participants were recruited to the screening program. Thirty-nine patients (38.2%) had an abnormal endoscopic ultrasound, and two patients (2.0%) were diagnosed with PC and two with other malignancies. Those with a personal history of cancer or a positive BRCA2 mutation demonstrated significantly increased worry about developing other types of cancer at baseline (p < 0.01). Irrespective of EUS result, there was a significant decrease of total IES score at 1 year (Z = − 2.0, p = 0.041). In patients with abnormal EUS results, there was a decrease in the total IES score at 1 year (Z = − 2.5, p = 0.011). In participants deemed to be most distressed at baseline based on their negative PCQ score, there was a significant decrease of the total PCQ (Z = − 3.2, p = 0.001), emotional (Z = − 3.0, p = 0.001), social (Z = 3.0, p = 0.001) and physical (Z = − 2.8, p = 0.002) subscale at 1-year post-intervention. This study provides evidence of the long-term psychological benefits of PC screening in high-risk patients. There was no negative impact of screening in the short-term and the positive benefits appeared at 1-year post-intervention irrespective of screening result.
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References
Siegel RL, Miller KD, Jemal A (2018) Cancer statistics, 2016. CA Cancer J Clin 68(1):7–30
Rahib L, Smith BD, Aizenberg R, Rosenzweig AB, Fleshman JM, Matrisian LM (2014) Projecting cancer incidence and deaths to 2030: the unexpected burden of thyroid, liver, and pancreas cancers in the United States. Cancer Res 74(11):2913–2921
Howlader N, Noone A, Krapcho M, Garshell J, Neyman N, Altekruse S et al (2013) SEER cancer statistics review, 1975–2010. National Cancer Institute, Bethesda, p 12
Gilbert JW, Wolpin B, Clancy T, Wang J, Mamon H, Shinagare AB et al (2017) Borderline resectable pancreatic cancer: conceptual evolution and current approach to image-based classification. Ann Oncol 28(9):2067–2076
Shi C, Hruban RH, Klein AP (2009) Familial pancreatic cancer. Arch Pathol Lab Med 133(3):365–374
Klein AP, Brune KA, Petersen GM, Goggins M, Tersmette AC, Offerhaus GJA et al (2004) Prospective risk of pancreatic cancer in familial pancreatic cancer kindreds. Cancer Res 64(7):2634–2638
Permuth-Wey J, Egan KM (2009) Family history is a significant risk factor for pancreatic cancer: results from a systematic review and meta-analysis. Fam Cancer 8(2):109–117
Grover S, Syngal S (2010) Hereditary pancreatic cancer. Gastroenterology 139(4):1076
Tersmette AC, Petersen GM, Offerhaus GJA, Falatko FC, Brune KA, Goggins M et al (2001) Increased risk of incident pancreatic cancer among first-degree relatives of patients with familial pancreatic cancer. Clin Cancer Res 7(3):738–744
Giardiello FM, Brensinger JD, Tersmette AC, Goodman SN, Petersen GM, Booker SV et al (2000) Very high risk of cancer in familial Peutz-Jeghers syndrome. Gastroenterology 119(6):1447–1453
Canto MI, Harinck F, Hruban RH, Offerhaus GJ, Poley J-W, Kamel I et al (2013) International Cancer of the Pancreas Screening (CAPS) Consortium summit on the management of patients with increased risk for familial pancreatic cancer. Gut 62(3):339–347
Van Asperen C, Brohet R, Meijers-Heijboer E, Hoogerbrugge N, Verhoef S, Vasen H et al (2005) Cancer risks in BRCA2 families: estimates for sites other than breast and ovary. J Med Genet 42(9):711–719
Slater EP, Langer P, Niemczyk E, Strauch K, Butler J, Habbe N et al (2010) PALB2 mutations in European familial pancreatic cancer families. Clin Genet 78(5):490–494
Takai E, Yachida S, Shimizu K, Furuse J, Kubo E, Ohmoto A et al (2016) Germline mutations in Japanese familial pancreatic cancer patients. Oncotarget 7(45):74227–74235
Schneider R, Slater EP, Sina M, Habbe N, Fendrich V, Matthai E et al (2011) German national case collection for familial pancreatic cancer (FaPaCa): ten years experience. Fam Cancer 10(2):323–330
Southey MC, Goldgar DE, Winqvist R, Pylkas K, Couch F, Tischkowitz M et al (2016) PALB2, CHEK2 and ATM rare variants and cancer risk: data from COGS. J Med Genet 53(12):800–811
Lynch HT, Fusaro RM, Lynch JF, Brand R (2008) Pancreatic cancer and the FAMMM syndrome. Fam Cancer 7(1):103–112
Rebours V, Boutron-Ruault M-C, Schnee M, Férec C, Maire F, Hammel P et al (2008) Risk of pancreatic adenocarcinoma in patients with hereditary pancreatitis: a national exhaustive series. Am J Gastroenterol 103(1):111–119
Kastrinos F, Mukherjee B, Tayob N, Wang F, Sparr J, Raymond VM et al (2009) Risk of pancreatic cancer in families with Lynch syndrome. J Am Med Assoc 302(16):1790–1795
Ariyama J, Suyama M, Ogawa K, Ikari T (1986) Screening of pancreatic neoplasms and the diagnostic rate of small pancreatic neoplasms. Nihon Rinsho Jpn J Clin Med 44(8):1729–1734
Lu C, Xu C-F, Wan X-Y, Zhu H-T, Yu C-H, Li Y-M (2015) Screening for pancreatic cancer in familial high-risk individuals: a systematic review. World J Gastroenterol 21(28):8678
Capurso G, Signoretti M, Valente R, Arnelo U, Lohr M, Poley JW et al (2015) Methods and outcomes of screening for pancreatic adenocarcinoma in high-risk individuals. World J Gastrointest Endosc 7(9):833–842
Toft J, Hadden WJ, Laurence JM, Lam V, Yuen L, Janssen A et al (2017) Imaging modalities in the diagnosis of pancreatic adenocarcinoma: a systematic review and meta-analysis of sensitivity, specificity and diagnostic accuracy. Eur J Radiol 92:17–23
Raut C, Grau AM, Staerkel GA, Kaw M, Tamm EP, Wolff RA, Vauthey JN, Lee JE, Pisters PW, Evans DB (2003) Diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration in patients with presumed pancreatic cancer. J Gastrointest Surg 7:118–126
Breitkopf CR, Sinicrope PS, Rabe KG, Brockman TA, Patten CA, McWilliams RR et al (2012) Factors influencing receptivity to future screening options for pancreatic cancer in those with and without pancreatic cancer family history. Hered Cancer Clin Pract 10(1):8
Horowitz M, Wilner N, Alvarez W (1979) Impact of event scale: a measure of subjective stress. Psychosom Med 41(3):209–218
Zilberg NJ, Weiss DS, Horowitz MJ (1982) Impact of event scale: a cross-validation study and some empirical evidence supporting a conceptual model of stress response syndromes. J Consult Clin Psychol 50(3):407
Cella DF, Mahon SM, Donovan MI (1990) Cancer recurrence as a traumatic event. Behav Med 16(1):15–22
Cockburn J, De Luise T, Hurley S, Clover K (1992) Development and validation of the PCQ: a questionnaire to measure the psychological consequences of screening mammography. Soc Sci Med 34(10):1129–1134
Lerman C, Trock B, Rimer BK, Jepson C, Brody D, Boyce A (1991) Psychological side effects of breast cancer screening. Health Psychol 10(4):259
Paiella S, Capurso G, Cavestro GM, Butturini G, Pezzilli R, Salvia R et al (2019) Results of first-round of surveillance in individuals at high-risk of pancreatic cancer from the AISP (Italian Association for the Study of the Pancreas) registry. Am J Gastroenterol 114(4):665–670
Signoretti M, Bruno MJ, Zerboni G, Poley J-W, Delle Fave G, Capurso G (2018) Results of surveillance in individuals at high-risk of pancreatic cancer: a systematic review and meta-analysis. United Eur Gastroenterol J 6(4):489–499
Konings IC, Harinck F, Kuenen MA, Sidharta GN, Kieffer JM, Aalfs CM et al (2017) Factors associated with cancer worries in individuals participating in annual pancreatic cancer surveillance. Fam Cancer 16(1):143–151
Douma KF, Aaronson NK, Vasen HF, Gerritsma MA, Gundy CM, Janssen EP et al (2010) Psychological distress and use of psychosocial support in familial adenomatous polyposis. Psycho-Oncology 19(3):289–298
Franke FS, Matthäi E, Slater EP, Schicker C, Kruse J, Bartsch DK (2018) German National Case Collection for familial pancreatic Cancer (FaPaCa)-acceptance and psychological aspects of a pancreatic cancer screening program. Hered Cancer Clin Pract 16(1):17
Maheu C, Vodermaier A, Rothenmund H, Gallinger S, Ardiles P, Semotiuk K et al (2010) Pancreatic cancer risk counselling and screening: impact on perceived risk and psychological functioning. Fam Cancer 9(4):617–624
Konings IC, Sidharta GN, Harinck F, Aalfs CM, Poley JW, Kieffer JM et al (2016) Repeated participation in pancreatic cancer surveillance by high-risk individuals imposes low psychological burden. Psycho-Oncology 25(8):971–978
Cazacu IM, Chavez AAL, Saftoiu A, Bhutani MS (2019) Psychological impact of pancreatic cancer screening by EUS or magnetic resonance imaging in high-risk individuals: a systematic review. Endosc Ultrasound 8(1):17
Mckay S, Gunasingam N, Meiser B, Williams DB, Stoita A (2017) Pancreatic cancer screening in high risk individuals does not have negative psychological impact in the short or long term. Gastroenterology 152(5):S277
Hart SL, Torbit LA, Crangle CJ, Esplen MJ, Holter S, Semotiuk K et al (2012) Moderators of cancer-related distress and worry after a pancreatic cancer genetic counseling and screening intervention. Psycho-Oncology. 21(12):1324–1330
Wu GX, Raz DJ, Brown L, Sun V (2016) Psychological burden associated with lung cancer screening: a systematic review. Clin Lung Cancer 17(5):315–324
Brett J, Bankhead C, Henderson B, Watson E, Austoker J (2005) The psychological impact of mammographic screening. A systematic review. Psychooncology 14(11):917–938
Brain KE, Lifford KJ, Fraser L, Rosenthal AN, Rogers MT, Lancastle D et al (2012) Psychological outcomes of familial ovarian cancer screening: no evidence of long-term harm. Gynecol Oncol 127(3):556–563
Cantor SB, Volk RJ, Cass AR, Gilani J, Spann SJ (2002) Psychological benefits of prostate cancer screening: the role of reassurance. Health Expect 5(2):104–113
Kirkøen B, Berstad P, Botteri E, Åvitsland TL, Ossum AM, De Lange T et al (2016) Do no harm: no psychological harm from colorectal cancer screening. Br J Cancer 114(5):497
Gopie JP, Vasen HF, Tibben A (2012) Surveillance for hereditary cancer: does the benefit outweigh the psychological burden?—a systematic review. Crit Rev Oncol/Hematol 83(3):329–340
Corral JE, Das A, Bruno MJ, Wallace MB (2019) Cost-effectiveness of pancreatic cancer surveillance in high-risk individuals: an economic analysis. Pancreas 48(4):526–536
Lewis ZK, Frost CJ, Venne VL (2009) Pancreatic cancer surveillance among high-risk populations: knowledge and intent. J Genet Counsel 18(3):229–238
Harinck F, Nagtegaal T, Kluijt I, Aalfs C, Smets E, Poley J-W et al (2011) Feasibility of a pancreatic cancer surveillance program from a psychological point of view. Genet Med 13(12):1015–1024
Canto MI, Almario JA, Schulick RD, Yeo CJ, Klein A, Blackford A et al (2018) Risk of neoplastic progression in individuals at high risk for pancreatic cancer undergoing long-term surveillance. Gastroenterology 155(3):740–751
Corral JE, Mareth KF, Riegert-Johnson DL, Das A, Wallace MB (2019) Diagnostic yield from screening asymptomatic individuals at high risk for pancreatic cancer: a meta-analysis of cohort studies. Clin Gastroenterol Hepatol 17(1):41–53
Hruban RH, Canto M, Goggins M, Schulick R, Klein AP (2010) Update on familial pancreatic cancer. Adv Surg 44:293
Al-Sukhni W, Borgida A, Rothenmund H, Holter S, Semotiuk K, Grant R et al (2012) Screening for pancreatic cancer in a high-risk cohort: an eight-year experience. J Gastrointest Surg 16(4):771–783
Canto MI, Hruban RH, Fishman EK, Kamel IR, Schulick R, Zhang Z et al (2012) Frequent detection of pancreatic lesions in asymptomatic high-risk individuals. Gastroenterology 142(4):796–804
Topazian M, Enders F, Kimmey M, Brand R, Chak A, Clain J et al (2007) Interobserver agreement for EUS findings in familial pancreatic-cancer kindreds. Gastrointest Endosc 66(1):62–67
Acknowledgements
We would like to thank the participants for their involvement and the medical practitioners who referred their patients to the screening program. We would like to acknowledge Prof Kathy Tucker, Prof Alan Spiegelman and Dr Lesley Andrews for their expert advice on genetic counselling and testing and Dr Marcia Canto for her contribution to the initial screening program development. A special thanks is given to Prof Andrew Biankin, Prof Anthony Gill, Ms Amber Jones and Australian Pancreatic Cancer Genome Initiative network for their support and ongoing collaboration: http://pancreaticcancer.net.au/about-collaborators. We also acknowledge Ms Skye Mackay, who was the trial coordinator until 2017 and Ms Tanya Dwarte who is the current trial coordinator. Bettina Meiser is supported through a Senior Research Fellowship Level B from the National Health and Medical Research Council.
Funding
The Clinical Research Coordinator positions were supported by PanCare Foundation.
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Dr O’Neill was involved in writing the manuscript and data analysis. Professor Bettina Meiser was involved in designing the psychological questionnaire and reviewing the manuscript. Dr David Williams contributed to the research design, provided revisions to ethics documents, performed screening and revised the final manuscript. Dr Sam Emmanuel was involved in statistical analysis. Dr Alina Stoita developed the screening program; prepared documents for ethics submission, assisted in participant recruitment, performed screening and provided revisions to the manuscript.
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Conflict of interest
Robert O’Neill, Sam Emmanuel, David Williams and Alina Stoita declare they have no conflict of interest.
Ethical approval
All procedures performed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 [5]. Informed consent was obtained from all patients for being included in the study. Bettina Meiser had a remunerated consultant role with the company Astrazeneca with respect to an unrelated project. No animal studies were carried out by the authors for this article.
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Appendix: Inclusion criteria
Appendix: Inclusion criteria
Australian Pancreatic Cancer Screening Program
Inclusion criteria
High risk group 1: familial pancreatic cancer
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a.
Aged 50–80 years (or 10 years younger than the youngest relative with PC, AND
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b.
Member of a family with 2 or more blood relatives with PC on the same side of the family. If only 2 family members are affected, both must be an FDR of the individual being screened. If there are ≥ 3 affected family members, at least one must be an FDR of the individual being screened.
High risk group 2: Peutz–Jeghers syndrome
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a.
Age > 30 years old and < 80 years old, AND
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b.
Clinical diagnosis of Peutz-Jeghers Syndrome or carrier of a germline STK11 pathogenic variant.
High risk group 3: BRCA2 pathogenic variant carriers
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a.
Age > 40 years old and < 80 years old (or 10 years younger than the youngest relative with PC) AND
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b.
Patient is a carrier of a BRCA2 pathogenic variant AND
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c.
There is ≥ 1 pancreatic cancer in the family (FDR or SDR, confirmed or likely carrier of the pathogenic variant)
High risk group 4: hereditary pancreatitis
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a.
Age > 40 years old and < 80 years old (or 10 years younger than the youngest relative with PC) AND
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b.
Previous diagnosis of Hereditary Pancreatitis or known carrier of a PRSS1 or SPINK1 pathogenic variant.
High risk group 5: PALB2 gene carrier*
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a.
Age > 50 years old and < 80 years old (or 10 years younger than the youngest relative with PC) AND
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b.
Patient is a carrier of a PALB2 pathogenic variant AND
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c.
There is ≥ 1 pancreatic cancer in the family (FDR or SDR, confirmed or likely carrier of the pathogenic variant)
High risk group 6: lynch syndrome mutation carrier /hereditary non polyposis colorectal cancer mutation carrier (MLH1, PMS2, MSH6, MSH2 mutation)*
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a.
Age > 50 years old and < 80 years old (or 10 years younger than the youngest relative with PC) AND
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b.
Patient is a Lynch syndrome mutation carrier AND
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c.
There is a ≥1 FDR with pancreatic cancer
High risk group 7: familial atypical multiple melanoma moles (FAMMM) syndrome (CDKN2A/p16 mutation carrier)*
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a.
Age > 50 years old and < 80 years old (or 10 years younger than the youngest relative with PC) AND
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b.
Patient is a carrier of p16/ CDKN2A pathogenic variant
*Groups 5, 6, 7 were added in 2018 and are not included in the current paper
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O’Neill, R.S., Meiser, B., Emmanuel, S. et al. Long-term positive psychological outcomes in an Australian pancreatic cancer screening program. Familial Cancer 19, 23–35 (2020). https://doi.org/10.1007/s10689-019-00147-3
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DOI: https://doi.org/10.1007/s10689-019-00147-3