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Study: Benefit of pancreatic cancer screening

Summary

Among people with an inherited mutation in a BRCA1 or BRCA2 gene, screening for pancreatic cancer found most cancers at an earlier stage when they could be treated by surgery. Posted 1/17/24)

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Benefit of pancreatic cancer screening

RELEVANCE

Most relevant for: People with an inherited BRCA1 or BRCA2 mutation. It may also be relevant for:

  • previvors
  • people with a genetic mutation linked to cancer risk
  • people with a family history of cancer
  • people with pancreatic cancer

Relevance: Medium-High

Strength of Science: Medium-High

Research Timeline: Post Approval

Relevance Rating Details


What is this study about?

This research study looked at how well screening for pancreatic cancer found cancer in people with an inherited or mutation. It also looked at the health outcomes for people who were diagnosed with pancreatic cancer during the study.

Why is this study important?

Expert guidelines outline screening recommendations for people at high-risk for pancreatic cancer.  Guidelines created by different expert groups may sometimes differ slightly. Currently, four organizations have guidelines related to pancreatic cancer screening. These guidelines are frequently updated based on new research. 

The National Comprehensive Cancer Network (NCCN) guidelines recommend screening for pancreatic cancer for all people with an in an or CDKN2A gene, regardless of their family history.  For people with other inherited mutations, including or , the NCCN recommends screening only when a close family member (a or ) has been diagnosed with pancreatic cancer. However, the American Society for Gastrointestinal Endoscopy (ASGE) guidelines suggest screening for people with an inherited or mutation regardless of family history.

Guidelines may conflict when research evidence is insufficient for all experts to agree on the best approach to care.

This study focused on and mutation carriers. The findings may help clarify whether pancreatic cancer screening improves outcomes, specifically for people with inherited mutations in and .

Study findings

This study included 180 people. Fifty-seven (32%) had a mutation and 121 (67%) had a mutation. Two (1%) had both a and mutation. Twelve participants (7%) had an in another gene (APC, or ) that increased risk in addition to a mutation in or . Of the 180 participants, sixty-four participants (35%) did not have a family history of pancreatic cancer.

Most (82%) of the participants were . Almost 70% of these participants had one of the three common and Ashkenazi Jewish mutations. 

Participants were screened every year with one of two types of pancreatic cancer screening:

  • Endoscopic (EUS): A special procedure done under conscious sedation using a small attached to an endoscope.
  • MRCP (magnetic resonance cholangiopancreatography): A special type of imaging test to look at the pancreas and surrounding structures. 

Screening was done at six large academic centers in Israel from 2011 to 2021:

At the first screening and follow-up screening, 48 participants (27%) had an abnormal finding. Of these:

  • 40 had pancreatic cysts. While pancreatic cysts are not cancer, some are precancerous, which means that they could develop into pancreatic cancer.
  • 8 had cancer found with pancreatic screening (and all 8 had a mutation):
    • 4 had pancreatic cancer.
    • 4 had pancreatic neuroendocrine tumors (NETs).
       

The results of the screenings were as follows:

Result

Participants

Had family history of pancreatic cancer

No family history of pancreatic cancer

No findings

132

84

48

Pancreatic cysts (non-cancer)

40

26

14

Pancreatic cancer

4

3

1

Pancreatic neuroendocrine tumor (NET)

4

3

1

 

Pancreatic neuroendocrine tumors (NETs), also called islet cell tumors, are less common types of pancreatic cancers. They make up less than 2 percent of pancreatic cancers but tend to have a better outlook (prognosis) than the more common type.

While few pancreatic cancers were detected in this study, most (75 percent) were at an early when they could be surgically removed. Only 15-20 percent of pancreatic cancers in the US are detected at an early .

Among people with a mutation, screening detected cancer at an early when the cancer could be removed by surgery.

What does this mean for me?

If you have an in a gene that increases your risk for pancreatic cancer or if someone in your family has such a mutation or has been diagnosed with pancreatic cancer, you should discuss with your healthcare provider or genetic counselor whether or not to have pancreatic cancer screening. Pancreatic cancer screening is highly specialized, so if you do decide to have screening, experts recommend having your screening done at a hospital with considerable experience in screening for pancreatic cancer.

While a family history is important in determining an individual’s cancer risk, not all people know their family history. Research is ongoing to identify those who are most at risk and in need of screening, but  results from this study show that having screening for individuals with or mutations can lead to successful earlier detection of pancreatic cancer.

Reference

Laish I, Schechter M, Dancour A, Lieberman S, et al. The benefit of pancreatic cancer surveillance in carriers of germline BRCA1/2 pathogenic variants. Cancer. 2023 Oct 20. doi: 10.1002/cncr.35052. Epub ahead of print. PMID: 37861363.

Sawhney M, Calderwood A, Thosani C, et al. ASGE guideline on screening for pancreatic cancer in individuals with genetic susceptibility: summary and recommendations. Gastrointestinal Endoscopy Online; 2022; 5(95).

Syngal S, Brand RE, Church JM, et al. ACG clinical guideline: genetic testing and management of hereditary gastrointestinal cancer syndromes. American Journal of Gastroenterology: 2015; 110(2), 223-263.

Disclosure: FORCE receives funding from industry sponsors, including companies that manufacture cancer drugs, tests and devices. All XRAYS articles are written independently of any sponsor and are reviewed by members of our Scientific Advisory Board prior to publication to assure scientific integrity.

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Questions To Ask Your Doctor
Questions To Ask Your Doctor

  • Should I consider pancreatic cancer screening?
  • When should I start pancreatic screening?
  • What protocol does this hospital follow for pancreatic screening?
  • What additional measures can I take besides screening to lower my risk for pancreatic cancer?

Open clinical trials
Open clinical trials

The following studies are looking at risk management for pancreatic cancer:

A number of other clinical trials for pancreatic cancer screening and prevention may be found here.

Updated: 06/18/2022

Guidelines
Guidelines

National Comprehensive Cancer Network (NCCN) Guidelines

The NCCN recommends the following screening for people at increased risk for pancreatic cancer: 

  • Discuss the benefits and risks of screening with their doctor. Screening should be performed by a facility that is experienced with screening for pancreatic cancer. The recommended age for considering screening depends on a person’s family history of pancreatic cancer and varies by type of gene mutation.
    • Consider screening with magnetic resonance cholangiopancreatography (MRCP) and/or endoscopic  (EUS).
    • Consider participating in a pancreatic cancer screening study.

The NCCN recommends that people with inherited mutations in the following genes (with or without a family history of cancer) "consider pancreatic cancer screening" with MRCP or EUS:

  • : (): Consider pancreatic cancer screening by MRCP or EUS every 1-2 years, beginning at ages 30-35 or 10 years younger than the earliest pancreatic cancer in the family.
  • CDKN2A: Consider pancreatic cancer screening beginning at age 40 or 10 years earlier than the earliest pancreatic cancer diagnosis in the family.

NCCN guidelines recommend that people with an in one of the following genes and a family history of cancer "consider pancreatic cancer screening" with MRCP or EUS, beginning at age 50 or 10 years earlier than the earliest pancreatic cancer diagnosis in the family: 

The NCCN does not currently recommend pancreatic cancer screening for people with the above mutations who do not have a family history of cancer. 

American Society for Gastrointestinal Endoscopy (ASGE) Guidelines

In February 2022, the ASGE released updated guidelines on pancreatic cancer screening for people with a or mutation. These guidelines recommended:

  • All patients with a mutation, regardless of family history of pancreatic cancer, should undergo annual screening for pancreatic cancer with MRI/MRCP or EUS, beginning at age 50 (or 10 years earlier than the earliest pancreatic cancer in the family).  

Updated: 07/03/2022

Finding experts
Finding experts

The organization, Collaborative Group of the Americas- Inherited Gastrointestinal Cancer (CGA-IGC) curates an updated list of hospitals and programs with expertise in pancreatic cancer screening for high-risk people. 

Register for the FORCE Message Boards to get referrals from other members. Once you register, you can post on the Find a Specialist board to connect with other people who share your situation. 

Updated: 06/18/2022

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