International Cancer of the Pancreas Screening (CAPS) Consortium summit on the management of patients with increased risk for familial pancreatic cancer
- Marcia Irene Canto1,
- Femme Harinck2,
- Ralph H Hruban3,
- George Johan Offerhaus4,
- Jan-Werner Poley2,
- Ihab Kamel5,
- Yung Nio6,
- Richard S Schulick7,
- Claudio Bassi8,
- Irma Kluijt9,
- Michael J Levy10,
- Amitabh Chak11,
- Paul Fockens12,
- Michael Goggins1,
- Marco Bruno2,
- on behalf of the International Cancer of the Pancreas Screening (CAPS) Consortium
- 1Department of Medicine (Gastroenterology), Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
- 2Department of Gastroenterology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- 3Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
- 4Department of Pathology, University Medical Center, Utrecht, The Netherlands
- 5Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
- 6Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
- 7Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
- 8Department of Surgery, University of Verona, Verona, Italy
- 9Department of Oncology, Academic Medical Center, Amsterdam, The Netherlands
- 10Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA
- 11Division of Gastroenterology, University Hospitals of Cleveland, Cleveland Ohio, USA
- 12Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands
- 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;
- Received 19 June 2012
- Accepted 17 September 2012
- Published Online First 7 November 2012
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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