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.
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.
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)