PT  - JOURNAL ARTICLE
AU  - Marcia Irene Canto
AU  - Femme Harinck
AU  - Ralph H Hruban
AU  - George Johan Offerhaus
AU  - Jan-Werner Poley
AU  - Ihab Kamel
AU  - Yung Nio
AU  - Richard S Schulick
AU  - Claudio Bassi
AU  - Irma Kluijt
AU  - Michael J Levy
AU  - Amitabh Chak
AU  - Paul Fockens
AU  - Michael Goggins
AU  - Marco Bruno
TI  - International Cancer of the Pancreas Screening (CAPS) Consortium summit on the management of patients with increased risk for familial pancreatic cancer
AID  - 10.1136/gutjnl-2012-303108
DP  - 2013 Mar 01
TA  - Gut
PG  - 339--347
VI  - 62
IP  - 3
4099  - http://gut.bmj.com/content/62/3/339.short
4100  - http://gut.bmj.com/content/62/3/339.full
SO  - Gut2013 Mar 01; 62
AB  - 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.