Pancreatic Cancer Screening for At-Risk Individuals (Pancreas Scan Study): Yield, Harms, and Outcomes From a Prospective Multicenter Study

• Published in: The American journal of gastroenterology Vol. 118; no. 9; pp. 1664 - 1670
• Main Authors: Shah, Ishani, Silva-Santisteban, Andy, Germansky, Katharine A, Trindade, Arvind, Raphael, Kara L, Kushnir, Vladimir, Pawa, Rishi, Mishra, Girish, Anastasiou, Jiannis, Inamdar, Sumant, Tharian, Benjamin, Bilal, Mohammad, Sawhney, Mandeep S
• Format: Journal Article
• Language: English
• Published: United States Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins 01-09-2023
• Subjects: Breast cancer; Carcinoma, Pancreatic Ductal - pathology; Diabetes; Early Detection of Cancer; Enrollments; Family medical history; Female; Gastroenterology; Humans; Hypothesis testing; Male; Medical screening; Middle Aged; Mutation; Ovarian cancer; Pancreas - pathology; Pancreatic cancer; Pancreatic Intraductal Neoplasms - pathology; Pancreatic Neoplasms - diagnostic imaging; Pancreatic Neoplasms - pathology; Pancreatitis; Patients; Prospective Studies; Surgery; United States > US
• ISSN: 0002-9270; 1572-0241
• DOI: 10.14309/ajg.0000000000002314

Guidelines endorse pancreatic cancer screening in genetically susceptible individuals. We conducted a prospective, multicenter study to determine yield, harms, and outcomes of pancreatic cancer screening.
All high-risk individuals undergoing pancreatic cancer screening at 5 centers from 2020 to 2022 were prospectively enrolled. Pancreas findings were designated as low-risk (fatty or chronic pancreatitis-like changes), intermediate-risk (neuroendocrine tumor [NET] <2 cm or branch-duct intraductal papillary mucinous neoplasm [IPMN]), or high-risk lesions (high-grade pancreatic intraepithelial neoplasia/dysplasia, main-duct IPMN, NET >2 cm, or pancreatic cancer). Harms from screening included adverse events during screening or undergoing low-yield pancreatic surgery. Annual screening was performed using endoscopic ultrasound and or magnetic resonance cholangiopancreatography. Annual screening for new-onset diabetes using fasting blood sugar was also performed ( ClinicalTrials.gov : NCT05006131).
During the study period, 252 patients underwent pancreatic cancer screening. Mean age was 59.9 years, 69% were female, and 79.4% were White. Common indications were BRCA 1/2 (36.9%), familial pancreatic cancer syndrome kindred (31.7%), ataxia telangiectasia mutated (3.5%), Lynch syndrome (6.7%), Peutz-Jeghers (4.3%), and familial atypical multiple mole melanoma (3.5%). Low-risk lesions were noted in 23.4% and intermediate-risk lesions in 31.7%, almost all of which were branch-duct IPMN without worrisome features. High-risk lesions were noted in 2 patients (0.8%), who were diagnosed with pancreas cancer at stages T2N1M0 and T2N1M1. Prediabetes was noted in 18.2% and new-onset diabetes in 1.7%. Abnormal fasting blood sugar was not associated with pancreatic lesions. There were no adverse events from screening tests, and no patient underwent low-yield pancreatic surgery.
Pancreatic cancer screening detected high-risk lesions with lower frequency than previously reported. No harms from screening were noted.