Although the detection of pancreatic cancer at early stages would offer an improved chance for successful treatment and survival, symptoms of pancreatic cancer are usually vague or absent, and screening to detect pancreatic cancer earlier is not recommended for average-risk asymptomatic patients. The U.S. Preventive Services Task Force (USPSTF) is currently updating its recommendations for pancreatic cancer screening, but according to its draft recommendation statement, “there is no new evidence that warrants a change” in the recommendation against screening in asymptomatic adults.1
“Approximately 5% to 10% of cases of pancreatic adenocarcinoma are familial with no known genetic mutations,” the USPSTF reported in its draft evidence review of pancreatic cancer screening.2 “According to one meta-analysis and one pooled analysis, having a positive family history for pancreatic adenocarcinoma (defined as having at least one first-degree relative with pancreatic adenocarcinoma in most studies) is associated with a relative risk of 1.8.”
Inherited genetic mutations occur in an estimated 3% to 5% of cases of pancreatic adenocarcinoma, the task force noted. Known genetic mutations in this setting include those in BRCA1, BRCA2, and ATM; also associated with pancreatic cancer, Lynch syndrome can be caused by a germline mutation in MLH1, MSH2, MSH6, or PMS2.
According to the USPSTF, endoscopic ultrasonography and magnetic resonance imaging “are considered the most accurate” imaging tools for pancreatic cancer. These tools “are used primarily for diagnostic testing,” the task force notes, “but may also have a role in screening for people at high risk of pancreatic adenocarcinoma, such as those with known genetic mutations or a family history of pancreatic adenocarcinoma.” ■
REFERENCES
1. U.S. Preventive Services Task Force: Draft Recommendation Statement: Pancreatic Cancer: Screening. February 2019. Available at www.uspreventiveservicestaskforce.org/page/document/draft-recommendation-statement/pancreatic-cancer-screening1. Accessed May 2, 2019.
2. U.S. Preventive Services Task Force: Draft Evidence Review: Pancreatic Cancer: Screening. February 2019. Available at www.uspreventiveservicestaskforce.org/Page/Document/draft-evidence-review/pancreatic-cancer-screening1. Accessed May 2, 2019.
