RT Journal Article
SR Electronic
T1 Refinement of screening for familial pancreatic cancer
JF Gut
JO Gut
FD BMJ Publishing Group Ltd and British Society of Gastroenterology
SP 1314
OP 1321
DO 10.1136/gutjnl-2015-311098
VO 65
IS 8
A1 D K Bartsch
A1 E P Slater
A1 A Carrato
A1 I S Ibrahim
A1 C Guillen-Ponce
A1 H F A Vasen
A1 E Matthäi
A1 J Earl
A1 F S Jendryschek
A1 J Figiel
A1 M Steinkamp
A1 A Ramaswamy
A1 E Vázquez-Sequeiros
A1 M Muñoz-Beltran
A1 J Montans
A1 E Mocci
A1 B A Bonsing
A1 M Wasser
A1 G Klöppel
A1 P Langer
A1 V Fendrich
A1 T M Gress
YR 2016
UL http://gut.bmj.com/content/65/8/1314.abstract
AB Objective Surveillance programmes are recommended for individuals at risk (IAR) of familial pancreatic cancer (FPC) to detect early pancreatic cancer (pancreatic ductal adenocarcinoma, PDAC). However, the age to begin screening and the optimal screening protocol remain to be determined.Methods IAR from non-CDKN2A FPC families underwent annual screening by MRI with endoscopic ultrasonography (EUS) in board-approved prospective screening programmes at three tertiary referral centres. The diagnostic yield according to age and different screening protocols was analysed.Results 253 IAR with a median age of 48 (25–81) years underwent screening with a median of 3 (1–11) screening visits during a median follow-up of 28 (1–152) months. 134 (53%) IAR revealed pancreatic lesions on imaging, mostly cystic (94%), on baseline or follow-up screening. Lesions were significantly more often identified in IAR above the age of 45 years (p<0.0001). In 21 IAR who underwent surgery, no significant lesions (PDAC, pancreatic intraepithelial neoplasia (PanIN) 3 lesions, high-grade intraductal papillary mucinous neoplasia (IPMN)) were detected before the age of 50 years. Potentially relevant lesions (multifocal PanIN2 lesions, low/moderate-grade branch-duct IPMNs) occurred also significantly more often after the age of 50 years (13 vs 2, p<0.0004). The diagnostic yield of potentially relevant lesions was not different between screening protocols using annual MRI with EUS (n=98) or annual MRI with EUS every 3rd year (n=198) and between IAR screened at intervals of 12 months (n=180) or IAR that decided to be screened at ≥24 months intervals (n=30).Conclusions It appears safe to start screening for PDAC in IAR of non-CDKN2a FPC families at the age of 50 years. MRI-based screening supplemented by EUS at baseline and every 3rd year or when changes in MRI occur appears to be efficient.