Objective: Familial pancreatic cancer (FPC) accounts for approximately 3% of all pancreatic cancer (PC) cases. It has been suggested that high-risk individuals (HRI) should be offered a screening program.
Aim: To evaluate the diagnostic yield of a prospective screening program in HRIs from familial pancreatic cancer syndrome (FPC) over a period of 5 years.
Design: Prospective study.
Individuals and methods: HRI of FPC families of the German National Case Collection for familial pancreatic cancer (FaPaCa) were counselled and enrolled in a prospective, board-approved PC screening program. Screening included clinical examination, laboratory tests, endoscopic ultrasound (EUS) and magnetic resonance imaging (MRI) with MRCP and MR-angiography.
Results: Between 6/2002 and 12/2007, 76 HRI families took part in the screening program with a total of 182 examination visits. Twenty-eight patientes 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. Histopathologic examination of the resected specimens showed serous oligocystic adenomas (n=3), PanIN1 lesions with lobular fibrosis (n=1), PanIN2 lesions (n=1) and PanIN1 lesion plus a gastric type IPMN (n=1).
Conclusions: In FPC an EUS/MR-MRCP-based screening program leads to the detection of potential precursor lesions of PC. However, the yield of an extensive screening program is low, especially since the tumourogenic value of low grade PanIN-lesions is not yet defined. Taken into account the enormous psychological stress for the tested individual and the high costs, a general PC screening in HRI is not justified.
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