Researchers have identified a novel strategy to screen for pancreatic cancer in high-risk patients, according to a recent study published by Zogopoulos et al in JNCCN–Journal of the National Comprehensive Cancer Network. The findings demonstrated the feasibility of improving the early detection and prevention of pancreatic cancer.
Background
In recent years, the global incidence of pancreatic cancer has risen significantly, but the overall survival rate is currently just 12%. Although the survival rate of patients with pancreatic neoplasms detected early enough for treatment with surgical resection is more than 80%, a majority of patients are diagnosed with advanced-stage disease.
Study Methods and Results
Through the Pancreatic Cancer Early Detection (PRECEDE) Consortium—a global effort to increase screening capacity for pancreatic cancer—nearly 80% of the 1,759 study participants categorized into the highest-risk cohort completed baseline imaging.
“Individuals who are concerned they are at risk for pancreatic cancer can participate in PRECEDE and obtain an assessment from a PRECEDE site,” explained co–lead study author George Zogopoulos, MD, PhD, of the Research Institute at the McGill University Health Centre and the Rosalind and Morris Goodman Cancer Institute at McGill University. “If the individual is assessed to be at increased risk for pancreatic cancer, [he or she] will have the opportunity to undergo clinical surveillance for pancreatic cancer according to the clinical surveillance services available in the area.
In the high-risk group, the incidence of pancreatic cysts was higher among the participants sorted on the basis of family history alone compared with those with a known genetic predisposition for pancreatic cancer but no family history of the disease.
“The presence of cysts may identify individuals that are at increased risk of developing pancreatic cancer over time because of cyst changes or because the presence of cysts signals that the pancreas has an intrinsic aberration, making it more susceptible to cyst progression or other precancerous growths,” stressed senior study author Diane M. Simeone, MD, of the University of California, San Diego Moores Cancer Center. “Longer follow-up time is needed to determine if familial pancreatic cancer signifies a higher risk for developing pancreatic cancer compared to pathogenic germline variant status in a pancreatic cancer predisposition gene,” she added.
Conclusions
“Based on our findings, we recommend sorting individuals at high risk for pancreatic cancer into three groups based on family history of pancreatic cancer, the existence of a potentially cancer-causing genetic mutation, or both,” suggested Dr. Zogopoulos.
“This research highlights that—although barriers have prevented the widespread implementation of pancreatic cancer screening programs for high-risk individuals—a multicenter international consortium and longitudinal study are feasible; early imaging findings from this study show the need for further pancreatic cancer early detection research,” underscored Cassadie Moravek, BS, Senior Director of Clinical Trial Portfolio and Program Management at the Pancreatic Cancer Action Network and a patient advocate on the NCCN Clinical Practice Guidelines in Oncology Panel for Pancreatic Adenocarcinoma. “Low overall survival rates in pancreatic cancer are often attributed to the majority of patients having advanced-stage disease at diagnosis, underscoring the need for improved screening for pancreatic cancer to detect the disease at earlier stages. While the NCCN Guidelines for Genetic/Familial High-Risk Assessment: Breast, Ovarian, and Pancreatic recommend pancreatic cancer screening in select individuals based on known pathogenic germline variants and family history, this study showed that further research in this area is needed to better tailor surveillance to distinct subclassifications of high-risk individuals. The study also identifies a high prevalence of pancreatic cysts in high-risk individuals that do not fully overlap with risks based on known pathologic genetic alterations. I look forward to further research in this area, building upon the infrastructure support of this international consortium, to improve access to pancreatic cancer screening for high-risk individuals, and in turn, advance early detection of pancreatic cancer and improve clinical outcomes,” she concluded.
Disclosure: For full disclosures of the study authors, visit jnccn.org.
