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Gut 62:339-347 doi:10.1136/gutjnl-2012-303108
  • Guidelines

International Cancer of the Pancreas Screening (CAPS) Consortium summit on the management of patients with increased risk for familial pancreatic cancer

Open Access
  1. 1Department of Medicine (Gastroenterology), Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
  2. 2Department of Gastroenterology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
  3. 3Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
  4. 4Department of Pathology, University Medical Center, Utrecht, The Netherlands
  5. 5Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
  6. 6Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
  7. 7Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
  8. 8Department of Surgery, University of Verona, Verona, Italy
  9. 9Department of Oncology, Academic Medical Center, Amsterdam, The Netherlands
  10. 10Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA
  11. 11Division of Gastroenterology, University Hospitals of Cleveland, Cleveland Ohio, USA
  12. 12Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands
  1. Correspondence to Dr Marcia Irene Canto, Division of Gastroenterology, Johns Hopkins University, The Sol Goldman Pancreatic Cancer Research Center, 1830 E Monument Street, Room 427, Baltimore, MD 21205, USA; mcanto{at}jhmi.edu
  • Received 19 June 2012
  • Accepted 17 September 2012
  • Published Online First 7 November 2012

Abstract

Background Screening individuals at increased risk for pancreatic cancer (PC) detects early, potentially curable, pancreatic neoplasia.

Objective To develop consortium statements on screening, surveillance and management of high-risk individuals with an inherited predisposition to PC.

Methods A 49-expert multidisciplinary international consortium met to discuss pancreatic screening and vote on statements. Consensus was considered reached if ≥75% agreed or disagreed.

Results There was excellent agreement that, to be successful, a screening programme should detect and treat T1N0M0 margin-negative PC and high-grade dysplastic precursor lesions (pancreatic intraepithelial neoplasia and intraductal papillary mucinous neoplasm). It was agreed that the following were candidates for screening: first-degree relatives (FDRs) of patients with PC from a familial PC kindred with at least two affected FDRs; patients with Peutz–Jeghers syndrome; and p16, BRCA2 and hereditary non-polyposis colorectal cancer (HNPCC) mutation carriers with ≥1 affected FDR. Consensus was not reached for the age to initiate screening or stop surveillance. It was agreed that initial screening should include endoscopic ultrasonography (EUS) and/or MRI/magnetic resonance cholangiopancreatography not CT or endoscopic retrograde cholangiopancreatography. There was no consensus on the need for EUS fine-needle aspiration to evaluate cysts. There was disagreement on optimal screening modalities and intervals for follow-up imaging. When surgery is recommended it should be performed at a high-volume centre. There was great disagreement as to which screening abnormalities were of sufficient concern to for surgery to be recommended.

Conclusions Screening is recommended for high-risk individuals, but more evidence is needed, particularly for how to manage patients with detected lesions. Screening and subsequent management should take place at high-volume centres with multidisciplinary teams, preferably within research protocols.

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