RT Journal Article
SR Electronic
T1 Management of patients with increased risk for familial pancreatic cancer: updated recommendations from the International Cancer of the Pancreas Screening (CAPS) Consortium
JF Gut
JO Gut
FD BMJ Publishing Group Ltd and British Society of Gastroenterology
SP gutjnl-2019-319352
DO 10.1136/gutjnl-2019-319352
A1 Michael Goggins
A1 Kasper Alexander Overbeek
A1 Randall Brand
A1 Sapna Syngal
A1 Marco Del Chiaro
A1 Detlef K Bartsch
A1 Claudio Bassi
A1 Alfredo Carrato
A1 James Farrell
A1 Elliot K Fishman
A1 Paul Fockens
A1 Thomas M Gress
A1 Jeanin E van Hooft
A1 R H Hruban
A1 Fay Kastrinos
A1 Allison Klein
A1 Anne Marie Lennon
A1 Aimee Lucas
A1 Walter Park
A1 Anil Rustgi
A1 Diane Simeone
A1 Elena Stoffel
A1 Hans F A Vasen
A1 Djuna L Cahen
A1 Marcia Irene Canto
A1 Marco Bruno
A1 ,
YR 2019
UL http://gut.bmj.com/content/early/2019/11/18/gutjnl-2019-319352.abstract
AB Background and aim The International Cancer of the Pancreas Screening Consortium met in 2018 to update its consensus recommendations for the management of individuals with increased risk of pancreatic cancer based on family history or germline mutation status (high-risk individuals).Methods A modified Delphi approach was employed to reach consensus among a multidisciplinary group of experts who voted on consensus statements. Consensus was considered reached if ≥75% agreed or disagreed.Results Consensus was reached on 55 statements. The main goals of surveillance (to identify high-grade dysplastic precursor lesions and T1N0M0 pancreatic cancer) remained unchanged. Experts agreed that for those with familial risk, surveillance should start no earlier than age 50 or 10 years earlier than the youngest relative with pancreatic cancer, but were split on whether to start at age 50 or 55. Germline ATM mutation carriers with one affected first-degree relative are now considered eligible for surveillance. Experts agreed that preferred surveillance tests are endoscopic ultrasound and MRI/magnetic retrograde cholangiopancreatography, but no consensus was reached on how to alternate these modalities. Annual surveillance is recommended in the absence of concerning lesions. Main areas of disagreement included if and how surveillance should be performed for hereditary pancreatitis, and the management of indeterminate lesions.Conclusions Pancreatic surveillance is recommended for selected high-risk individuals to detect early pancreatic cancer and its high-grade precursors, but should be performed in a research setting by multidisciplinary teams in centres with appropriate expertise. Until more evidence supporting these recommendations is available, the benefits, risks and costs of surveillance of pancreatic surveillance need additional evaluation.