Consensus guideline recommends screening for some persons at high risk for pancreatic cancer

Reference

Goggins M, Overbeek KA, Brand R, et al, for the International Cancer of the Pancreas Screening (CAPS) consortium. Management of patients with increased risk for familial pancreatic cancer: updated recommendations from the International Cancer of the Pancreas Screening (CAPS) Consortium. Gut 2019;69(1):7-17.

Synopsis

The US Preventive Services Task Force (USPSTF) recommends against screening average-risk persons for pancreatic cancer, but the recommendation statement does not address screening in persons at increased risk. This consensus guideline (not associated with the USPSTF) used rounds of voting by a group of experts to try to arrive at consensus around pancreatic cancer screening in at-risk individuals, defined as: (1) anyone with a family history in at least 1 first-degree relative or 2 second-degree relatives (2) anyone with LKB1/STK11 (Peutz-Jeghers syndrome) or CDKN2A (Familial atypical multiple mole melanoma), regardless of family history (3) persons with PALB2, Lynch syndrome, ATM, or BRCA1, with at least one affected first-degree relative This guideline also recommends surveillance in persons regardless of gene mutation status who have a very strong family history, including at least 3 affected relatives on the same side of the family with at least 1 first-degree relative; 2 first-degree relatives who are first-degree relatives to each other, one of whom is first-degree relative to the person considering surveillance; or at least two affected relatives on the same side of the family, of whom at least one is first-degree relative to the patient. The latter 3 recommendations had declining levels of consensus as the number of affected family members decreased, from 97% to 93% to 88%. In the absence of data about biology, we tend to substitute anatomy (we have 10 digits, so 10 days of treatment) or astronomy (a screening test once a year), so this guideline recommends screening annually with either endoscopic ultrasound or magnetic resonance imaging with magnetic retrograde cholangiopancreatography. There are lots of other recommendations, but these are most relevant to a primary care audience. If a high-risk individual under surveillance develops diabetes mellitus, it shoud prompt immediate investigation.