USPSTF says ‘no’ to pancreatic cancer screening

GI cancer

By Mardi Chapman

8 Aug 2019

There is no value in screening for pancreatic cancer in asymptomatic adults at average risk of the disease, according to an update by the US Preventive Services Task Force (USPSTF).

The Task Force found no new evidence that screening for pancreatic cancer or treatment of screen-detected pancreatic cancer improves disease-specific morbidity or mortality, or all-cause mortality.

This is despite the high mortality associated with pancreatic cancer, in part due to detection at a late stage.

“Based on the low incidence of pancreatic cancer in the general population, the uncertain accuracy of current candidate screening tests, and the poor prognosis for pancreatic cancer even when treated at an early stage, the USPSTF found adequate evidence to bound the benefits of screening for pancreatic cancer in asymptomatic adults as no greater than small,” the Task Force said.

Their recommendations, published in JAMA said CT, MRI and endoscopic ultrasonography had not been shown to be accurate or validated screening tests for early detection of pancreatic cancer.

However the USTPF recommendation does not apply to people at higher than average risk of pancreatic cancer – those with inherited genetic syndromes or a history of familial pancreatic cancer.

Their Evidence Report noted that image-based screening in populations at high familial risk may result in a stage shift toward earlier stage at detection, and with minimal harm.

An accompanying editorial in JAMA said high-risk individuals, for example people with a 5-fold increased relative risk of pancreatic cancer, may benefit from surveillance.

“These include individuals from familial pancreatic cancer (FPC) kindreds (individuals with 2 or more blood relatives affected with pancreatic cancer, with at least 1 affected first-degree relative), whose risk increases with a greater number of affected family members or if those relatives developed cancer at a younger age,” the editorial said.

“Germline mutations in ATM, BRCA1, BRCA2, CDKN2A, PALB2, PRSS1, STK11, TP53, and the Lynch syndrome mismatch repair genes are also associated with an increased risk of pancreatic cancer.”

And there was emerging data that people with a diagnosis of new-onset diabetes have up to an 8-fold greater risk of pancreatic cancer.

“Further study is needed to fully define the population who should be screened and by what optimal strategy to improve outcomes and minimize harms resulting from pancreatic cancer surveillance in individuals at increased risk,” the editorial said.

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