What is the risk of pancreatic cancer in a patient with breast cancer?

From the Guidelines

Patients with breast cancer who are at high risk for pancreatic cancer should undergo genetic testing for hereditary cancer syndromes, particularly for BRCA1/2, CDKN2A, and other associated genes, as identified in the 2020 NCCN guidelines 1. The genetic testing is crucial in identifying individuals with a predisposition to pancreatic cancer, which can inform treatment decisions and screening strategies. According to the NCCN guidelines, genetic testing is warranted for patients with pancreatic cancer, and testing of first-degree relatives may be beneficial 1. The guidelines also recommend pancreas screening in individuals with a pathogenic or likely pathogenic variant associated with increased risk of exocrine pancreatic cancer, particularly if there is a family history of pancreatic cancer 1. Key considerations for screening include:

• For carriers of a CDKN2A pathogenic or likely pathogenic variant, screening may be considered at age 40 years, or 10 years younger than the earliest pancreatic cancer diagnosis in the family, whichever is earlier 1.
• For carriers of a STK11 pathogenic or likely pathogenic variant, screening may be considered beginning at age 30 to 35 years, or 10 years younger than the earliest pancreatic cancer diagnosis in the family, whichever is earlier 1.
• For other individuals with a family history of pancreatic cancer, screening may be considered at age 50 years, or 10 years younger than the earliest pancreatic cancer diagnosis in the family, whichever is earlier 1. Regular follow-up with both oncology and gastroenterology specialists is recommended to ensure appropriate surveillance based on individual risk factors. Risk reduction strategies, such as avoiding tobacco, limiting alcohol, maintaining a healthy weight, and consuming a diet rich in fruits and vegetables, should also be implemented to minimize the risk of pancreatic cancer 1.

From the Research

Pancreatic Cancer Screening for High-Risk Individuals

• Patients with breast cancer may be at high risk of pancreatic cancer, particularly those with genetic syndromes such as hereditary breast and ovarian cancer syndrome 2
• The American Gastroenterological Association Institute recommends pancreas cancer screening for high-risk individuals, including those with genetic syndromes associated with an increased risk of pancreas cancer, such as BRCA1, BRCA2, PALB2, and ATM genes 3
• Screening for pancreatic cancer in high-risk individuals should begin at age 50 years, or 10 years younger than the initial age of familial onset 3

Diagnostic Modalities for Pancreatic Cancer

• Endoscopic ultrasound (EUS) and magnetic resonance imaging (MRI) are the preferred screening modalities for individuals undergoing pancreas cancer screening 3
• EUS combined with fine-needle biopsy (FNB) has the highest specificity and sensitivity for detecting pancreatic cancer amongst available modalities 2
• MRI with abbreviated protocols has been increasingly evaluated for the follow-up of cystic lesions, and can be considered for surveillance in selected high-risk individuals 4

Management of Pancreatic Cancer

• Surgical resection is the only curative treatment for pancreatic cancer, but over 80% of patients present with unresectable disease 2
• EUS-guided therapies, such as radiofrequency ablation, brachytherapy, and intratumor chemotherapy, may be considered for patients with unresectable disease 2
• Decisions regarding therapy directed towards abnormal findings detected during screening should be made by a dedicated multidisciplinary team together with the high-risk individual and their family 3