Pancreatic Cancer: Screening
Dr. Fay Kastrinos, Director of the Muzzi Mirza Pancreatic Cancer Prevention and Genetics Program, recently asked readers to send her questions about the role of genetics and family history in pancreatic cancer. What follows is the second in a three-part series of the most popular questions with Dr. Kastrinos’ answers.
Is screening available for the general population?
Since the average person’s risk of developing pancreatic cancer in their lifetime is low (approximately 1%), screening is not recommended for the general population.
Screening for pancreatic cancer is a topic of ongoing research. It is important to consider which patients are appropriate to screen and how best to screen them.
Individuals considered at high risk of developing pancreatic cancer have a greater than 5% lifetime risk, or five times increased risk.
Recommendations for screening are primarily based on evidence of increased risk, rather than the proven efficacy of the screening test(s).
Who should be considered for screening?
Studies have considered the following patients appropriate candidates for pancreatic cancer screening:
Patients with a family history of pancreatic cancer
- Individuals with 3 or more relatives with pancreatic cancer, with at least one affected first-degree relative
- Those with 2 or more affected first-degree relatives
- Individuals with two affected blood relatives with pancreatic cancer, with at least one first-degree relative
- Individuals with one first-degree relative with pancreatic cancer are currently not considered for screening
Patients with genetic syndromes associated with pancreatic cancer
- Patients with Peutz–Jeghers syndrome, regardless of family history of pancreatic cancer
- BRCA mutation carriers with one or more affected first-degree relative with pancreatic cancer and those with two or more affected family members (even without a first-degree relative)
- CDKN2A mutation carriers of FAMMM with one or more affected first-degree relative with pancreatic cancer
- Patients with Lynch syndrome and one affected first-degree relative with pancreatic cancer
- Patients with hereditary pancreatitis and PRSS1 gene mutations
When should a person consider screening?
The age to initiate screening in these high-risk individuals has been debated. Many research centers with protocols for pancreatic cancer screening currently initiate testing at age 50 years. Individualized recommendations are made however when relatives have been diagnosed with pancreatic cancer at young ages (i.e. younger than 50 years).
What screening options are available in high risk individuals?
The screening techniques studied for the early detection of pancreatic cancer are endoscopic ultrasound (EUS), CT scanning, and MRI scanning.
EUS and MRI are considered the most accurate tools for pancreatic imaging and do not involve ionizing radiation. Using these tests, doctors have been able to find early, treatable pancreatic cancers in some patients from high risk families.
Radiation exposure and the suboptimal detection rate of early pancreatic lesions with CT scanning has precluded it from being a routine pancreatic screening test.
There is currently no blood test available for the early detection of pancreatic cancer. There is a blood marker called CA 19-9 that is often elevated in patients with pancreatic cancer and is best used as a marker for response to treatment. It is not a good test for the detection of early pancreatic cancers or precancerous lesions due to the possibility of false negative results. When this marker is detected, the cancer is usually more advanced. Therefore, it is not a recommended test for the prevention or screening for pancreatic cancer.
Be sure to check out our next article in this series, Pancreatic Cancer: Risk Factors (other than family history).