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Bret T. Petersen, MD, FASGE

Associate Editor
Pancreatobiliary

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Biography

Bret T. Petersen, MD, FASGE is Professor of Medicine in the Division of Gastroenterology and Hepatology at the Mayo Clinic in Rochester, Minnesota. His practice is focused in the Mayo Pancreas Clinic and the Advanced Endoscopy Group. His professional interests include pancreatic and biliary diseases, performance and outcomes of ERCP, and delivery of endoscopic services. At Mayo, Dr. Petersen is a past Director of Endoscopy and has served on multiple clinic and foundation committees. He has directed numerous American Society for Gastrointestinal Endoscopy (ASGE) and Mayo courses, particularly related to the performance of ERCP. He has received the Mayo Award for Excellence, GI Fellows Award for Outstanding Teacher, and Department of Medicine Laureate Award (GI), as well as the Master Endoscopist Award of the ASGE. Dr. Petersen is the incoming Secretary for (ASGE) and a past Chair of the Technology and Quality Assurance in Endoscopy committees.

Disclosures

Consultant 

Boston Scientific 

Advisory Board 

Ethicon/J & J

 

Summaries

Screening for High-Risk Pancreatic Cancer

Bret T. Petersen, MD, FASGE reviewing Corral JE, et al. Clin Gastroenterol Hepatol 2018 May 15.

Diagnostic yield from screening asymptomatic individuals at high risk for pancreatic cancer: a meta-analysis of cohort studies

Questions about whether and how to screen individuals at high risk for pancreatic cancer are often raised in clinical practice. This meta-analysis examined 19 studies encompassing more than 7000 patients at high risk for cancer on the basis of family history or genetic traits. Among 1660 patients screened for high-risk pancreatic lesions (high-grade pancreatic intraepithelial neoplasia, high-grade dysplasia, or adenocarcinoma) using EUS or MRI, 59 high-risk lesions were identified, including 28 carcinomas at the initial examination and 15 in subsequent examinations. The yield of screening for high-risk pancreatic lesions was 0.74 per 100 patient years (95% CI, 0.33–1.14). The number of patients who needed to be screened to identify 1 patient with a high-risk lesion was 135 (95% CI, 88–303). In addition, the authors calculated that 253 to 281 patients need to be screened to prevent 1 death from pancreatic cancer.


Comment:

Overall, pancreatic cancer has a dismal prognosis. The International Cancer of the Pancreas Screening Consortium proposes that screening be performed on patients with a demonstrable lifetime risk higher than 5% (versus 1% in the general population). This would apply to individuals with known high-risk genetic mutations plus a history of pancreatic cancer in 1 first-degree family member, 2 first-degree family members, or 3 family members, including 1 first-degree member. Heterogeneity among studies in this meta-analysis likely reduced the yield in cancer detection, compared to more recent individual series. While the yield was similar for those with varied high-risk genetic features and screening using EUS or MRI, evolving literature suggests high variability in risk among genetic abnormalities and that EUS is more sensitive than MRI for screening. As outlined in the accompanying editorial (Hart and Chari), experts are reaching greater consensus regarding the indications for screening. Nevertheless, further studies are needed to determine for which individuals screening reduces mortality and whether it is cost effective across populations.

Note to readers:
At the time we reviewed these papers, the publisher noted that they were not in final form and that subsequent changes might be made.

Bret T. Petersen, MD, FASGE
Bio and Disclosures

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Citation(s):

Corral JE, Mareth KF, Riegert-Johnson DL, et al. Diagnostic yield from screening asymptomatic individuals at high risk for pancreatic cancer: a meta-analysis of cohort studies. Clin Gastroenterol Hepatol 2018 May 15 (Epub ahead of print) (https://doi.org/10.1016/j.cgh.2018.04.065)

Hart PA and Chari ST. Is screening for pancreatic cancer in high-risk individuals one step closer or a fool’s errand? Clin Gastroenterol Hepatol 2018 Sep 27 (Epub ahead of print) (https://doi.org/10.1016/j.cgh.2018.09.024)