International Cancer of the Pancreas Screening (CAPS) Consortium summit on the management of patients with increased risk for familial pancreatic cancer

✍ Scribed by Canto, M. I.; Harinck, F.; Hruban, R. H.; Offerhaus, G. J.; Poley, J.-W.; Kamel, I.; Nio, Y.; Schulick, R. S.; Bassi, C.; Kluijt, I.; Levy, M. J.; Chak, A.; Fockens, P.; Goggins, M.; Bruno, M.; Arcidiacono, P. G.; Bartsch, D.; Biermann, K.; Brentnall, T.; Chak, A.; Dite, P.; Donahue, T.; Early, D.; Farrell, J.; Castillo, C. F.-D.; Frucht, H.; Fukushima, N.; Geurts, J.; Hamell, P.; Iglesias-Garcia, J.; Klein, A.; Kloeppel, G.; Lachter, J.; Langer, P.; Lee, J.; Levy, M.; Maguchi, H.; Margolis, D.; Ohtsuka, T.; Olson, S.; Petersen, G.; Savides, T.; Syngal, S.; Tamm, E.; Tanaka, M.; Vasen, H.; Wagner, A.; Wang, H.; Williams, D.; Yamao, K.

• Book ID: 121711717
• Publisher: BMJ Publishing Group
• Year: 2012
• Tongue: English
• Weight: 237 KB
• Volume: 62
• Category: Article
• ISSN: 0017-5749
• DOI: 10.1136/gutjnl-2012-303108

✦ Synopsis

Background

Screening individuals at increased risk for pancreatic cancer (PC) detects early, potentially curable, pancreatic neoplasia.

Objective

To develop consortium statements on screening, surveillance and management of high-risk individuals with an inherited predisposition to PC.

Methods

A 49-expert multidisciplinary international consortium met to discuss pancreatic screening and vote on statements. Consensus was considered reached if ≥75% agreed or disagreed.

Results

There was excellent agreement that, to be successful, a screening programme should detect and treat T1N0M0 margin-negative PC and high-grade dysplastic precursor lesions (pancreatic intraepithelial neoplasia and intraductal papillary mucinous neoplasm). It was agreed that the following were candidates for screening: first-degree relatives (FDRs) of patients with PC from a familial PC kindred with at least two affected FDRs; patients with Peutz–Jeghers syndrome; and p16, __BRCA__2 and hereditary non-polyposis colorectal cancer (HNPCC) mutation carriers with ≥1 affected FDR. Consensus was not reached for the age to initiate screening or stop surveillance. It was agreed that initial screening should include endoscopic ultrasonography (EUS) and/or MRI/magnetic resonance cholangiopancreatography not CT or endoscopic retrograde cholangiopancreatography. There was no consensus on the need for EUS fine-needle aspiration to evaluate cysts. There was disagreement on optimal screening modalities and intervals for follow-up imaging. When surgery is recommended it should be performed at a high-volume centre. There was great disagreement as to which screening abnormalities were of sufficient concern to for surgery to be recommended.

Conclusions

Screening is recommended for high-risk individuals, but more evidence is needed, particularly for how to manage patients with detected lesions. Screening and subsequent management should take place at high-volume centres with multidisciplinary teams, preferably within research protocols.