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Pancreatic cancer surveillance and its ongoing challenges: is it time to refine our eligibility criteria?
  1. Thomas P Potjer
  1. Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
  1. Correspondence to Dr Thomas P Potjer, Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands; t.p.potjer{at}lumc.nl

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Individuals at high risk for pancreatic cancer (PC) could potentially benefit from regular surveillance, as the first clinical symptoms of PC often appear only at an advanced stage, at which point the prognosis is often dismal. PC surveillance is therefore aimed at the timely detection and surgical resection of still curable lesions in usually asymptomatic patients. In a guideline developed by the International Cancer of the Pancreas Screening (CAPS) Consortium, high-risk individuals (HRIs) eligible for surveillance are defined as those with either a strong family history of PC (familial pancreatic cancer; FPC) or those with a germline mutation in a high-risk PC susceptibility gene such as CDKN2A, STK11 or BRCA2. The preferred imaging modality is endoscopic ultrasound (EUS) and/or MRI/magnetic resonance cholangiopancreatography (MRCP).1 2 In a series of mostly small and short-term studies published since the early 2000s, the diagnostic yield of PC surveillance varied widely.2 However, more recent, larger studies with long-term follow-up have found evidence of increased survival among CDKN2A mutation carriers3 and HRIs from FPC families,4 thereby supporting continued PC surveillance of HRIs in a research setting.

In Gut, Overbeek et al5 now report the yield of long-term surveillance in one of the largest cohorts of HRIs to date (n=366). A major strength of the study design was the routine genetic counselling and testing of individuals prior to enrollment, which allowed the authors to compare the yield of surveillance between HRIs …

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Footnotes

  • Contributors TP wrote the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Commissioned; internally peer reviewed.

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  • Pancreas
    Kasper A Overbeek Iris J M Levink Brechtje D M Koopmann Femme Harinck Ingrid C A W Konings Margreet G E M Ausems Anja Wagner Paul Fockens Casper H van Eijck Bas Groot Koerkamp Olivier R C Busch Marc G Besselink Barbara A J Bastiaansen Lydi M J W van Driel Nicole S Erler Frank P Vleggaar Jan-Werner Poley Djuna L Cahen Jeanin E van Hooft Marco J Bruno on behalf of the Dutch Familial Pancreatic Cancer Surveillance Study Group M J Bruno D L Cahen J W Poley L M J W van Driel F Harinck I C A W Konings K A Overbeek I J M Levink B D M Koopmann A Wagner B Groot Koerkamp C H van Eijck K Biermann M P Peppelenbosch N S Erler P Fockens J E van Hooft B A J Bastiaansen M van der Vlugt O R Busch M G Besselink M G E M Ausems M E Velthuizen F P Vleggaar H van Dullemen E M A Bleiker M A Kuenen