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Pancreatic Cancer Screening

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Imaging Diagnostics in Pancreatic Cancer

Part of the book series: Clinical Gastroenterology ((CG))

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Abstract

The incidence of pancreatic cancer is on the rise, and as a result, screening for pancreatic cancer is, ipso facto, a matter of increased discussion in the medical literature. Consequently, with the increasing amount of research targeting the natural history of pancreatic cancer, we are getting closer, but are still relatively far from confidently answering the questions of who and when to screen for pancreatic cancer. In this chapter, we will discuss the current evidence for pancreatic cancer screening in populations at risk, as well as the available data on when to start screening. The chapter will also discuss the advantages and pitfalls of the different diagnostic modalities and briefly touch on current and future research endeavors.

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References

  1. Cancer today [Internet]. [cited 2019 Jul 27]. Available from: http://gco.iarc.fr/today/home.

  2. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin. 2019;69(1):7–34.

    Article  PubMed  Google Scholar 

  3. Rahib L, Smith BD, Aizenberg R, Rosenzweig AB, Fleshman JM, Matrisian LM. Projecting cancer incidence and deaths to 2030: the unexpected burden of thyroid, liver, and pancreas cancers in the United States. Cancer Res. 2014;74(11):2913–21.

    Article  CAS  PubMed  Google Scholar 

  4. Singhi AD, Koay EJ, Chari ST, Maitra A. Early detection of pancreatic cancer: opportunities and challenges. Gastroenterology. 2019;156(7):2024–40.

    Article  PubMed  Google Scholar 

  5. Yu J, Blackford AL, Dal Molin M, Wolfgang CL, Goggins M. Time to progression of pancreatic ductal adenocarcinoma from low-to-high tumour stages. Gut. 2015;64(11):1783–9.

    Article  PubMed  Google Scholar 

  6. Vasen H, Ibrahim I, Ponce CG, Slater EP, Matthäi E, Carrato A, et al. Benefit of surveillance for pancreatic cancer in high-risk individuals: outcome of long-term prospective follow-up studies from three European expert centers. J Clin Oncol. 2016;34(17):2010–9.

    Article  CAS  PubMed  Google Scholar 

  7. Canto MI, Almario JA, Schulick RD, Yeo CJ, Klein A, Blackford A, 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.

    Article  PubMed  Google Scholar 

  8. Canto MI, Harinck F, Hruban RH, Offerhaus GJ, Poley J-W, Kamel I, 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.

    Article  PubMed  Google Scholar 

  9. Owens DK, Davidson KW, Krist AH, Barry MJ, Cabana M, Caughey AB, et al. Screening for pancreatic cancer: US preventive services task force reaffirmation recommendation statement. JAMA. 2019;322(5):438–44.

    Article  PubMed  Google Scholar 

  10. Canto MI, Kerdsirichairat T, Yeo CJ, Hruban RH, Shin EJ, Almario JA, 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.

    Article  PubMed  Google Scholar 

  11. Corral JE, Das A, Bruno MJ, Wallace MB. Cost-effectiveness of pancreatic cancer surveillance in high-risk individuals: an economic analysis. Pancreas. 2019;48(4):526–36.

    Article  PubMed  Google Scholar 

  12. Corral JE, Mareth KF, Riegert-Johnson DL, Das A, Wallace MB. 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.

    Article  PubMed  Google Scholar 

  13. Schneider R, Slater EP, Sina M, Habbe N, Fendrich V, Matthäi E, et al. German national case collection for familial pancreatic cancer (FaPaCa): ten years experience. Familial Cancer. 2011;10(2):323–30.

    Article  PubMed  Google Scholar 

  14. Klein AP, Brune KA, Petersen GM, Goggins M, Tersmette AC, Offerhaus GJA, et al. Prospective risk of pancreatic cancer in familial pancreatic cancer kindreds. Cancer Res. 2004;64(7):2634–8.

    Article  CAS  PubMed  Google Scholar 

  15. Paiella S, Capurso G, Cavestro GM, Butturini G, Pezzilli R, Salvia R, et al. 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. 2019;114(4):665–70.

    Article  PubMed  Google Scholar 

  16. Lowenfels AB, Maisonneuve P, Whitcomb DC. Risk factors for cancer in hereditary pancreatitis. International Hereditary Pancreatitis Study Group. Med Clin North Am. 2000;84(3):565–73.

    Article  CAS  PubMed  Google Scholar 

  17. Lowenfels AB, Maisonneuve P, DiMagno EP, Elitsur Y, Gates LK, Perrault J, et al. Hereditary pancreatitis and the risk of pancreatic cancer. International Hereditary Pancreatitis Study Group. J Natl Cancer Inst. 1997;89(6):442–6.

    Article  CAS  PubMed  Google Scholar 

  18. Rebours V, Boutron-Ruault M-C, Schnee M, Férec C, Maire F, Hammel P, et al. Risk of pancreatic adenocarcinoma in patients with hereditary pancreatitis: a national exhaustive series. Am J Gastroenterol. 2008;103(1):111–9.

    Article  PubMed  Google Scholar 

  19. Lal G, Liu G, Schmocker B, Kaurah P, Ozcelik H, Narod SA, et al. Inherited predisposition to pancreatic adenocarcinoma: role of family history and germ-line p16, BRCA1, and BRCA2 mutations. Cancer Res. 2000;60(2):409–16.

    CAS  PubMed  Google Scholar 

  20. Hahn SA, Greenhalf B, Ellis I, Sina-Frey M, Rieder H, Korte B, et al. BRCA2 germline mutations in familial pancreatic carcinoma. J Natl Cancer Inst. 2003;95(3):214–21.

    Article  CAS  PubMed  Google Scholar 

  21. Hu C, Hart SN, Polley EC, Gnanaolivu R, Shimelis H, Lee KY, et al. Association between inherited germline mutations in cancer predisposition genes and risk of pancreatic cancer. JAMA. 2018;319(23):2401–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Shindo K, Yu J, Suenaga M, Fesharakizadeh S, Cho C, Macgregor-Das A, et al. Deleterious germline mutations in patients with apparently sporadic pancreatic adenocarcinoma. J Clin Oncol. 2017;35(30):3382–90.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Wood LD, Yurgelun MB, Goggins MG. Genetics of familial and sporadic pancreatic cancer. Gastroenterology. 2019;156(7):2041–55.

    Article  CAS  PubMed  Google Scholar 

  24. Ngamruengphong S, Canto MI. Screening for pancreatic cancer. Surg Clin North Am. 2016;96(6):1223–33.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Hu C, LaDuca H, Shimelis H, Polley EC, Lilyquist J, Hart SN, et al. Multigene hereditary cancer panels reveal high-risk pancreatic cancer susceptibility genes. JCO Precis Oncol. 2018;2:1–28.

    Google Scholar 

  26. van Lier MGF, Wagner A, Mathus-Vliegen EMH, Kuipers EJ, Steyerberg EW, van Leerdam ME. High cancer risk in Peutz-Jeghers syndrome: a systematic review and surveillance recommendations. Am J Gastroenterol. 2010;105(6):1258–64; author reply 1265.

    Article  PubMed  Google Scholar 

  27. Vasen HFA, Gruis NA, Frants RR, van der Velden PA, Hille ETM, Bergman W. 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.

    Article  CAS  PubMed  Google Scholar 

  28. Catts ZA-K, Baig MK, Milewski B, Keywan C, Guarino M, Petrelli N. Statewide retrospective review of familial pancreatic cancer in delaware, and frequency of genetic mutations in pancreatic cancer kindreds. Ann Surg Oncol. 2016;23(5):1729–35.

    Article  PubMed  Google Scholar 

  29. Wang W, Chen S, Brune KA, Hruban RH, Parmigiani G, Klein AP. PancPRO: risk assessment for individuals with a family history of pancreatic cancer. J Clin Oncol. 2007;25(11):1417–22.

    Article  PubMed  Google Scholar 

  30. Leonardi G, Marchi S, Falconi M, Zerbi A, Ussia V, de Bortoli N, et al. “PancPro” as a tool for selecting families eligible for pancreatic cancer screening: an Italian study of incident cases. Dig Liver Dis. 2012;44(7):585–8.

    Article  PubMed  Google Scholar 

  31. Yachida S, Jones S, Bozic I, Antal T, Leary R, Fu B, et al. Distant metastasis occurs late during the genetic evolution of pancreatic cancer. Nature. 2010;467(7319):1114–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Munigala S, Kanwal F, Xian H, Scherrer JF, Agarwal B. Increased risk of pancreatic adenocarcinoma after acute pancreatitis. Clin Gastroenterol Hepatol. 2014;12(7):1143–1150.e1.

    Article  PubMed  Google Scholar 

  33. Raimondi S, Lowenfels AB, Morselli-Labate AM, Maisonneuve P, Pezzilli R. Pancreatic cancer in chronic pancreatitis; aetiology, incidence, and early detection. Best Pract Res Clin Gastroenterol. 2010;24(3):349–58.

    Article  PubMed  Google Scholar 

  34. Kirkegård J, Mortensen FV, Cronin-Fenton D. Chronic pancreatitis and pancreatic cancer risk: a systematic review and meta-analysis. Am J Gastroenterol. 2017;112(9):1366–72.

    Article  PubMed  Google Scholar 

  35. Tanaka M, Fernández-del Castillo C, Adsay V, Chari S, Falconi M, Jang J-Y, et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology. 2012;12(3):183–97.

    Article  PubMed  Google Scholar 

  36. Tanaka M, Fernández-Del Castillo C, Kamisawa T, Jang JY, Levy P, Ohtsuka T, et al. Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology. 2017;17(5):738–53.

    Article  PubMed  Google Scholar 

  37. Tanaka M. Intraductal papillary mucinous neoplasm of the pancreas as the main focus for early detection of pancreatic adenocarcinoma. Pancreas. 2018;47(5):544–50.

    Article  PubMed  Google Scholar 

  38. Moutinho-Ribeiro P, Coelho R, Giovannini M, Macedo G. Pancreatic cancer screening: still a delusion? Pancreatology. 2017;17(5):754–65.

    Article  PubMed  Google Scholar 

  39. Hruban RH, Adsay NV, Albores-Saavedra J, Compton C, Garrett ES, Goodman SN, et al. Pancreatic intraepithelial neoplasia: a new nomenclature and classification system for pancreatic duct lesions. Am J Surg Pathol. 2001;25(5):579–86.

    Article  CAS  PubMed  Google Scholar 

  40. Hruban RH, Maitra A, Goggins M. Update on pancreatic intraepithelial neoplasia. Int J Clin Exp Pathol. 2008;1(4):306–16.

    CAS  PubMed  PubMed Central  Google Scholar 

  41. Sah RP, Nagpal SJS, Mukhopadhyay D, Chari ST. New insights into pancreatic cancer-induced paraneoplastic diabetes. Nat Rev Gastroenterol Hepatol. 2013;10(7):423–33.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Chari ST, Leibson CL, Rabe KG, Ransom J, de Andrade M, Petersen GM. Probability of pancreatic cancer following diabetes: a population-based study. Gastroenterology. 2005;129(2):504–11.

    Article  PubMed  Google Scholar 

  43. Pannala R, Leirness JB, Bamlet WR, Basu A, Petersen GM, Chari ST. Prevalence and clinical profile of pancreatic cancer-associated diabetes mellitus. Gastroenterology. 2008;134(4):981–7.

    Article  CAS  PubMed  Google Scholar 

  44. Sharma A, Smyrk TC, Levy MJ, Topazian MA, Chari ST. Fasting blood glucose levels provide estimate of duration and progression of pancreatic cancer before diagnosis. Gastroenterology. 2018;155(2):490–500.e2.

    Article  CAS  PubMed  Google Scholar 

  45. Sharma A, Kandlakunta H, Nagpal SJS, Feng Z, Hoos W, Petersen GM, et al. Model to determine risk of pancreatic cancer in patients with new-onset diabetes. Gastroenterology. 2018;155(3):730–739.e3.

    Article  PubMed  Google Scholar 

  46. Larsson SC, Orsini N, Wolk A. Body mass index and pancreatic cancer risk: a meta-analysis of prospective studies. Int J Cancer. 2007;120(9):1993–8.

    Article  CAS  PubMed  Google Scholar 

  47. Ulrich CD, Consensus Committees of the European Registry of Hereditary Pancreatic Diseases, Midwest Multi-Center Pancreatic Study Group, International Association of Pancreatology. Pancreatic cancer in hereditary pancreatitis: consensus guidelines for prevention, screening and treatment. Pancreatology. 2001;1(5):416–22.

    Article  CAS  PubMed  Google Scholar 

  48. Canto MI, Hruban RH, Fishman EK, Kamel IR, Schulick R, Zhang Z, et al. Frequent detection of pancreatic lesions in asymptomatic high-risk individuals. Gastroenterology. 2012;142(4):796–804.

    Article  PubMed  Google Scholar 

  49. DaVee T, Coronel E, Papafragkakis C, Thaiudom S, Lanke G, Chakinala RC, et al. Pancreatic cancer screening in high-risk individuals with germline genetic mutations. Gastrointest Endosc. 2018;87(6):1443–50.

    Article  PubMed  Google Scholar 

  50. Li J, He R, Li Y, Cao G, Ma Q, Yang W. Endoscopic ultrasonography for tumor node staging and vascular invasion in pancreatic cancer: a meta-analysis. Dig Surg. 2014;31(4–5):297–305.

    Article  CAS  PubMed  Google Scholar 

  51. Shin EJ, Topazian M, Goggins MG, Syngal S, Saltzman JR, Lee JH, et al. Linear-array EUS improves detection of pancreatic lesions in high-risk individuals: a randomized tandem study. Gastrointest Endosc. 2015;82(5):812–8.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Lee TH, Cho YD, Cha S-W, Cho JY, Jang JY, Jeong SW, et al. Endoscopic ultrasound elastography for the pancreas in Korea: a preliminary single center study. Clin Endosc. 2013;46(2):172–7.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Chantarojanasiri T, Kongkam P. Endoscopic ultrasound elastography for solid pancreatic lesions. World J Gastrointest Endosc. 2017;9(10):506–13.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Iglesias-García J, Lariño-Noia J, Domínguez-Muñoz JE. New imaging techniques: endoscopic ultrasound-guided elastography. Gastrointest Endosc Clin N Am. 2017;27(4):551–67.

    Article  PubMed  Google Scholar 

  55. Frič P, Škrha J, Šedo A, Zima T, Bušek P, Kmochová K, et al. Early detection of pancreatic cancer: impact of high-resolution imaging methods and biomarkers. Eur J Gastroenterol Hepatol. 2016;28(12):e33–43.

    Article  PubMed  CAS  Google Scholar 

  56. Dawwas MF, Taha H, Leeds JS, Nayar MK, Oppong KW. Diagnostic accuracy of quantitative EUS elastography for discriminating malignant from benign solid pancreatic masses: a prospective, single-center study. Gastrointest Endosc. 2012;76(5):953–61.

    Article  PubMed  Google Scholar 

  57. Opačić D, Rustemović N, Kalauz M, Markoš P, Ostojić Z, Majerović M, et al. Endoscopic ultrasound elastography strain histograms in the evaluation of patients with pancreatic masses. World J Gastroenterol. 2015;21(13):4014–9.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Altonbary AY, Hakim H, El-Shamy AM. Diagnostic efficacy of endoscopic ultrasound elastography in differentiating solid pancreatic lesions: a single-center experience. Clin Endosc. 2019;52(4):360–4.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Kitano M, Kudo M, Sakamoto H, Komaki T. Endoscopic ultrasonography and contrast-enhanced endoscopic ultra sonography. Pancreatology. 2011;11(Suppl. 2):28–33.

    Google Scholar 

  60. Saftoiu. The role of contrast-enhanced endoscopic ultrasound in pancreatic adenocarcinoma [Internet]. [cited 2019 Aug 5]. Available from: http://www.eusjournal.com/article.asp?issn=2303-9027;year=2016;volume=5;issue=6;spage=368;epage=372;aulast=Saftoiu.

  61. Hou X, Jin Z, Xu C, Zhang M, Zhu J, Jiang F, et al. Contrast-enhanced harmonic endoscopic ultrasound-guided fine-needle aspiration in the diagnosis of solid pancreatic lesions: a retrospective study. PLoS One. 2015;10(3):e0121236.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  62. Shin EJ, Canto MI. Pancreatic cancer screening. Gastroenterol Clin N Am. 2012;41(1):143–57.

    Article  Google Scholar 

  63. Francis IR. Pancreatic adenocarcinoma: diagnosis and staging using multidetector-row computed tomography (MDCT) and magnetic resonance imaging (MRI). Cancer Imaging. 2007;7 Spec No A:S160–5.

    Article  PubMed  Google Scholar 

  64. Chiaro MD, Verbeke CS, Kartalis N, Mucelli RP, Gustafsson P, Hansson J, et al. Short-term results of a magnetic resonance imaging–based Swedish screening program for individuals at risk for pancreatic cancer. JAMA Surg. 2015;150(6):512–8.

    Article  PubMed  Google Scholar 

  65. Harinck F, Konings ICAW, Kluijt I, Poley JW, van Hooft JE, van Dullemen HM, 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.

    Article  CAS  PubMed  Google Scholar 

  66. Rastegar N, Matteoni-Athayde LG, Eng J, Takahashi N, Tamm EP, Mortele KJ, et al. Incremental value of secretin-enhanced magnetic resonance cholangiopancreatography in detecting ductal communication in a population with high prevalence of small pancreatic cysts. Eur J Radiol. 2015;84(4):575–80.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Kauhanen S, Rinta-Kiikka I, Kemppainen J, Grönroos J, Kajander S, Seppänen M, et al. Accuracy of 18F-FDG PET/CT, multidetector CT, and MR imaging in the diagnosis of pancreatic cysts: a prospective single-center study. J Nucl Med. 2015;56(8):1163–8.

    Article  CAS  PubMed  Google Scholar 

  68. England CG, Hernandez R, Eddine SBZ, Cai W. Molecular imaging of pancreatic cancer with antibodies. Mol Pharm. 2016;13(1):8–24.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, University of Massachusetts Medical School – Baystate Campus, Springfield, MA, USA

    Jean M. Chalhoub

  2. Division of Gastroenterology and Hepatology, Staten Island University Hospital – Northwell Health, Staten Island, NY, USA

    Sherif Andrawes

  3. Zucker School of Medicine at Hofstra Northwell, Hempstead, NY, USA

    Sherif Andrawes

Authors
  1. Jean M. Chalhoub
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  2. Sherif Andrawes
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Correspondence to Sherif Andrawes .

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Editors and Affiliations

  1. Division of Gastroenterology and Hepatology, Norwalk Hospital, Nuvance Health, Norwalk, CT, USA

    Naveen Anand

  2. Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, USA

    Peter Darwin

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Chalhoub, J.M., Andrawes, S. (2021). Pancreatic Cancer Screening. In: Anand, N., Darwin, P. (eds) Imaging Diagnostics in Pancreatic Cancer. Clinical Gastroenterology. Humana, Cham. https://doi.org/10.1007/978-3-030-69940-6_8

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  • DOI: https://doi.org/10.1007/978-3-030-69940-6_8

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