Asaf Maoz, MD, on Pancreatic Surveillance Eligibility Criteria

Our study looked at pancreatic cancer surveillance eligibility criteria among individuals who have a genetic risk of pancreatic cancer. Individuals who carry a pathogenic germline variant in a pancreatic cancer predisposition gene have an elevated risk of pancreatic cancer over the lifetime, and when surveillance has been done for these individuals, we have seen that this results in an earlier stage at diagnosis and improved survival compared with historical cohorts. However, not everyone who carries a pathogenic germline variant that predisposes them to pancreatic cancer has been eligible for pancreatic cancer surveillance and eligibility criteria have restricted eligibility based on age and a family history of pancreatic cancer. Our study was meant to look at the proportion of pathogenic germline variant carriers who would have been eligible for pancreatic cancer surveillance at the time of their pancreatic cancer diagnosis, and we leveraged a laboratory cohort to look at this question. We had over 11,000 individuals in the cohort and over 900 individuals who had a pathogenic germline variant that predisposes them to pancreatic cancer. Our results show that the age criteria for pancreatic cancer surveillance eligibility did very well, with over 85% of individuals who had a pathogenic germline variant and developed pancreatic cancer meeting the age eligibility criteria for surveillance. However, the family history criteria did poorly with only 22% of individuals who carry pathogenic germline variants and developing pancreatic cancer meeting the family history criteria when it's applicable. Our results suggest that having a family history of pancreatic cancer needs to be reevaluated as an eligibility criteria for pancreatic cancer surveillance among those who have a genetic risk of pancreatic cancer. We feel that our results support the recent removal of the family history requirement for pancreatic cancer surveillance eligibility for those who have germline pathogenic variants in BRCA2 and ATM.