From the Guidelines
Pancreatic cancer screening is not currently recommended for the general population, but high-risk individuals, including those with a strong family history of pancreatic cancer or carriers of certain genetic mutations, may benefit from screening starting at age 50 or 10 years earlier than the youngest affected relative, using annual magnetic resonance imaging (MRI) with magnetic resonance cholangiopancreatography (MRCP) and/or endoscopic ultrasound (EUS) at centers with expertise in pancreatic diseases. For most people, routine screening tests like blood work or imaging are not advised because pancreatic cancer is relatively rare and current screening methods have limitations in detecting early disease 1. However, screening may be appropriate for high-risk individuals, including those with a strong family history of pancreatic cancer (two or more first-degree relatives), carriers of certain genetic mutations (BRCA1/2, PALB2, ATM, CDKN2A, Lynch syndrome genes), or those with hereditary pancreatitis 1. Some key points to consider when screening high-risk individuals include:
- The age to initiate surveillance depends on an individual's gene mutation status and family history, with some guidelines suggesting starting at age 50 or 10 years earlier than the youngest affected relative 1.
- The preferred surveillance tests are endoscopic ultrasound and MRI/magnetic retrograde cholangiopancreatography, although there is no consensus on how to alternate these modalities 1.
- Annual surveillance is recommended in the absence of concerning lesions, with shorter intervals for those with worrisome abnormalities 1.
- The goal of surveillance is to detect and treat stage I pancreatic cancer, confined to the pancreas, resected with negative margins, and pancreatic cancer precursor lesions with high-grade dysplasia 1. It's essential to weigh the benefits and risks of screening, considering the potential for downstaging and impact on mortality rates, as well as the risks of false positives and unnecessary procedures 1. Ultimately, pancreatic cancer screening should be performed at centers with expertise in pancreatic diseases, as interpretation requires significant experience, and individuals should be informed of the potential benefits and risks of screening 1.
From the Research
Guidelines for Pancreatic Cancer Screening
The current guidelines for pancreatic cancer screening are focused on early detection and screening only in patients at high risk for the development of the disease 2, 3, 4, 5, 6.
- High-Risk Individuals: These include kindreds with two or more first-degree relatives affected with pancreatic cancer and those with known hereditary pancreatic cancer syndromes, such as Peutz-Jeghers syndrome, familial breast cancer syndrome, and familial atypical multiple mole melanoma syndrome 2, 3, 4.
- Screening Modalities: Endoscopic ultrasound (EUS) is the most sensitive and specific screening tool to evaluate the pancreas and has been proven to detect early precancerous and cancerous changes in clinical studies 2, 3, 4, 6. Magnetic resonance cholangiopancreatography (MRCP) is also used for screening, and these techniques are generally considered to be complementary 3.
- Screening Intervals: The recommended screening intervals are not uniformly defined, but screening should be performed in individuals at high risk for pancreatic cancer, with the goal of identifying pancreatic cancer at an early, curable stage or, ideally, to identify precancerous lesions that can be resected to prevent the development of cancer 3, 5.
- Genetic Testing: Genetic testing should be performed in conjunction with genetic counseling, and testing of an affected family member is preferred if possible 3.
- Current State of Screening: Screening for pancreatic cancer in the general population is not currently viable due to the low incidence and lack of specific tests 4. However, screening in high-risk individuals has been shown to lead to downstaging of pancreatic cancer and improvements in survival 5.