Pancreatic cancer

Five years of prospective screening of high-risk individuals from families with familial pancreatic cancer

P Langer¹, P H Kann², V Fendrich¹, N Habbe¹, M Schneider¹, M Sina³, E P Slater¹, J T Heverhagen⁴, T M Gress⁵, M Rothmund¹, D K Bartsch¹

¹ Department of General Surgery, Philipps-University Marburg, Germany
² Division of Endocrinology and Diabetology, Philipps-University Marburg, Germany
³ Institute of Human Genetics, Philipps-University Marburg, Germany
⁴ Department of Radiology, Philipps-University Marburg, Germany
⁵ Department of Gastroenterology, Philipps-University Marburg, Germany

^{Correspondence to} Professor P Langer, Department of General Surgery, Philipps-University Marburg, Germany; langerp{at}med.uni-marburg.de

Objective: Familial pancreatic cancer (FPC) accounts for approximately 3% of all pancreatic cancer (PC) cases. It has been suggested that high-risk individuals (HRIs) should be offered a screening programme.

Aim: To evaluate the diagnostic yield of a prospective screening programme in HRIs from families with FPC over a period of 5 years.

Methods: HRIs of families with FPC of the National German Familial Pancreatic Cancer Registry (FaPaCa) were counselled and enrolled in a prospective, board-approved PC screening programme. Screening included clinical examination, laboratory tests, endoscopic ultrasound (EUS) and MRI with magnetic resonance cholangiopancreaticography (MRCP) and MR angiography.

Results: Between June 2002 and December 2007, 76 HRIs of families with FPC took part in the screening programme with a total of 182 examination visits. Twenty-eight patients revealed abnormalities in EUS (n = 25) and/or MR/MRCP (n = 12). In 7 patients fine needle aspiration cytology was performed. Operative pancreatic explorations were performed in 7 individuals, resulting in limited resections in 6 cases. Histopathological examination of the resected specimens showed serous oligocystic adenomas (n = 3), pancreatic intraepithelial neoplasia 1 (PanIN1) lesions with lobular fibrosis (n = 1), PanIN2 lesions (n = 1) and PanIN1 lesion plus a gastric type intraductal papillary mucinous neoplasm (IPMN) (n = 1).

Conclusions: In FPC an EUS/MR/MRCP-based screening programme leads to the detection of potential precursor lesions of PC. However, the yield of an extensive screening programme is low, especially since the tumourigenic value of low grade PanIN lesions is not yet defined. Taking into account the enormous psychological stress for the tested individual and the high costs, a general PC screening in HRIs is not justified.

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