New guidelines for pancreatic cancer screening released

BOSTON: By the year 2030, pancreatic cancer is expected to become the second most common cause of cancer deaths for both men and women in the United States, according to recent reports. While considered uncommon, inherited gene mutations can increase a person's risk of developing pancreatic cancer. Early detection of cancer is key to a greater chance of survival, but it is difficult to catch pancreatic cancer early as people usually have no symptoms until the cancer has advanced and hard to treat.

A clinician-researcher from Beth Israel Deaconess Medical Center (BIDMC) contributed to new national guidelines published by the American Society for Gastrointestinal Endoscopy (ASGE), recommending annual pancreatic cancer screening for patients who are at increased risk because of genetic susceptibility. While earlier guidelines had restricted screening to only those individuals with BRCA 1/2 who had a family history of pancreatic cancer, the new guidelines expand indication for screening for all with the gene variations regardless of family history.

"Because less than 25 percent of patients with BRCA 1/2 who develop pancreatic cancer have family history of pancreatic cancer, most cancers will be missed if screening is restricted to those with a family history" said first author of the guidelines Mandeep S. Sawhney, MD, MS, a gastroenterologist at BIDMC and associate professor of medicine at Harvard Medical School.

"Although screen-detected pancreatic cancers are more likely to be diagnosed at an earlier and more treatable stage, it is important to acknowledge the potential downsides of screening. These guidelines are the first to quantify harms from pancreatic cancer screening resulting from false-positive screening tests results and encourage care providers to carefully counsel their patients before enrolling in a screening program."

Following are few important recommendations --

In individuals at increased risk of pancreatic cancer because of genetic susceptibility, we suggest screening for pancreatic cancer compared with no screening (conditional, low quality).

In individuals at increased risk of pancreatic cancer because of genetic susceptibility, we suggest screening with EUS, EUS alternating with MRI, or MRI based on patient preference and available expertise (conditional, very low quality).

EUS may be preferred: as the initial screening test; for patients at very high risk for pancreatic cancer like Peutz-Jeghers syndrome and FAMMM; when EUS can be combined with screening upper endoscopy or colonoscopy (eg, Lynch and Peutz-Jeghers syndrome); when there is a contraindication to MRI (eg, claustrophobia, contrast allergy, implanted metal, and renal failure)

MRI may be preferred: for patients at increased risk of adverse events from anesthesia or invasive procedures; for patients who place a high value on avoiding invasive testing; when MRI may be combined with other imaging (eg, enterography for Peutz-Jeghers syndrome).

 In individuals with BRCA2 pathogenic variant, we suggest screening for pancreatic cancer compared with no screening (conditional, very low quality)

 In individuals with BRCA1 pathogenic variant, we suggest screening for pancreatic cancer compared with no screening (conditional, very low quality)

Read the full article at:

http://dx.doi.org/10.1016/j.gie.2021.12.001