1. Management of patients with increased risk for familial pancreatic cancer: updated recommendations from the International Cancer of the Pancreas Screening (CAPS) Consortium
- Author
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Goggins, M., Overbeek, K.A., Brand, R., Syngal, S., Chiaro, M. del, Bartsch, D.K., Bassi, C., Carrato, A., Farrell, J., Fishman, E.K., Fockens, P., Gress, T.M., Hooft, J.E. van, Hruban, R.H., Kastrinos, F., Klein, A., Lennon, A.M., Lucas, A., Park, W., Rustgi, A., Simeone, D., Stoffel, E., Vasen, H.F.A., Cahen, D.L., Canto, M.I., Bruno, M., Arcidiacono, P.G., Ashida, R., Ausems, M., Besselink, M., Biermann, K., Bonsing, B., Brentnall, T., Chak, A., Early, D., Fernandez-Del Castillo, C., Frucht, H., Furukawa, T., Gallinger, S., Geurts, J., Koerkamp, B.G., Hammel, P., Hes, F., Iglesias-Garcia, J., Kamel, I., Kitano, M., Kloppel, G., Krak, N., Kurtz, R., Kwon, R., Lachter, J., Lee, J., Levy, M., Malleo, G., Meguid, C., Maitra, A., Margolis, D., Offerhaus, J., Olson, S., Paiella, S., Petersen, G., Poley, J.W., Real, F.X., Saltzman, J., Schulick, R., Stoita, A., Takaori, K., Tanaka, M., Tamm, E., Topazian, M., Vazquez-Sequeiros, E., Vleggaar, F., Cappel, W.D.T.N., Yeo, C., Wasser, M., Wagner, A., Wallace, M., Wolfgang, C., Wood, L., Int Canc Pancreas Screening, Goggins, M., Overbeek, K. A., Brand, R., Syngal, S., Del Chiaro, M., Bartsch, D. K., Bassi, C., Carrato, A., Farrell, J., Fishman, E. K., Fockens, P., Gress, T. M., Van Hooft, J. E., Hruban, R. H., Kastrinos, F., Klein, A., Lennon, A. M., Lucas, A., Park, W., Rustgi, A., Simeone, D., Stoffel, E., Vasen, H. F. A., Cahen, D. L., Canto, M. I., Bruno, M, Arcidiacono, P. G., Gastroenterology & Hepatology, Clinical sciences, Medical Genetics, Gastroenterology and Hepatology, AGEM - Digestive immunity, AGEM - Re-generation and cancer of the digestive system, and CCA - Cancer Treatment and Quality of Life
- Subjects
Endoscopic ultrasound ,medicine.medical_specialty ,Biomedical Research ,MEDLINE ,pancreatic ductal adenocarcinoma ,familial pancreatic cancer ,Biomedical Research/methods ,Article ,Germline mutation ,Mass Screening/methods ,SDG 3 - Good Health and Well-being ,Risk Factors ,Pancreatic cancer ,medicine ,Humans ,Mass Screening ,Pancreatic Neoplasms/diagnosis ,Age Factor ,Genetic Predisposition to Disease ,Family history ,Intensive care medicine ,early detection ,Early Detection of Cancer ,Germ-Line Mutation ,Medicine(all) ,Hereditary pancreatitis ,medicine.diagnostic_test ,business.industry ,Carcinoma ,Age Factors ,Gastroenterology ,Pancreatic Neoplasm ,Cancer ,medicine.disease ,Carcinoma/diagnosis ,Population Surveillance/methods ,Pancreatic Neoplasms ,medicine.anatomical_structure ,Population Surveillance ,surveillance ,Early Detection of Cancer/methods ,business ,Pancreas ,genetic predisposition ,Human - Abstract
Background and aimThe International Cancer of the Pancreas Screening Consortium met in 2018 to update its consensus recommendations for the management of individuals with increased risk of pancreatic cancer based on family history or germline mutation status (high-risk individuals).MethodsA modified Delphi approach was employed to reach consensus among a multidisciplinary group of experts who voted on consensus statements. Consensus was considered reached if ≥75% agreed or disagreed.ResultsConsensus was reached on 55 statements. The main goals of surveillance (to identify high-grade dysplastic precursor lesions and T1N0M0 pancreatic cancer) remained unchanged. Experts agreed that for those with familial risk, surveillance should start no earlier than age 50 or 10 years earlier than the youngest relative with pancreatic cancer, but were split on whether to start at age 50 or 55. Germline ATM mutation carriers with one affected first-degree relative are now considered eligible for surveillance. Experts agreed that preferred surveillance tests are endoscopic ultrasound and MRI/magnetic retrograde cholangiopancreatography, but no consensus was reached on how to alternate these modalities. Annual surveillance is recommended in the absence of concerning lesions. Main areas of disagreement included if and how surveillance should be performed for hereditary pancreatitis, and the management of indeterminate lesions.ConclusionsPancreatic surveillance is recommended for selected high-risk individuals to detect early pancreatic cancer and its high-grade precursors, but should be performed in a research setting by multidisciplinary teams in centres with appropriate expertise. Until more evidence supporting these recommendations is available, the benefits, risks and costs of surveillance of pancreatic surveillance need additional evaluation.
- Published
- 2020