Management of patients with increased risk for familial pancreatic cancer

March's issue of Gut reports on the International Cancer of the Pancreas Screening Consortium summit on the management of patients with increased risk for familial pancreatic cancer.

Screening individuals at increased risk for pancreatic cancer detects early, potentially curable, pancreatic neoplasia.

Dr Marcia Irene Canto from Maryland, USA reviewed consortium statements on screening, surveillance and management of high-risk individuals with an inherited predisposition to pancreatic cancer.

The team report on the 49-expert multidisciplinary international consortium that met to discuss pancreatic screening and vote on statements.

Consensus was considered reached if 75% agreed or disagreed.

There was excellent agreement that, to be successful, a screening program should detect, and treat T1N0M0 margin-negative pancreatic cancer and high-grade dysplastic precursor lesions.

The researchers noted that candidates for screening, included first-degree relatives of patients with pancreatic cancer from a familial pancreatic cancer kindred with at least 2 affected first-degree relatives, patients with Peutz–Jeghers syndrome, and p16, BRCA2 and hereditary non-polyposis colorectal cancer mutation carriers with 1 affected first-degree relatives.

Screening is recommended for high-risk individuals

Gut

Consensus was not reached for the age to initiate screening or stop surveillance.

The team of doctors reported that it was agreed that initial screening should include endoscopic ultrasonography, and/or MRI/magnetic resonance cholangiopancreatography not CT or endoscopic retrograde cholangiopancreatography.

There was no consensus on the need for endoscopic ultrasonography  fine-needle aspiration to evaluate cysts.

The research team reported that there was disagreement on optimal screening modalities and intervals for follow-up imaging.

When surgery is recommended it should be performed at a high-volume center.

The team observed great disagreement as to which screening abnormalities were of sufficient concern to for surgery to be recommended.

Dr Canto's team concluded, "Screening is recommended for high-risk individuals, but more evidence is needed, particularly for how to manage patients with detected lesions."

"Screening and subsequent management should take place at high-volume centres with multidisciplinary teams, preferably within research protocols."