Individuals at high risk of pancreatic cancer benefit from annual imaging and have decreased mortality rates compared to those who forgo preventive screening.
An example of this was recently described in the Journal of Clinical Oncology, where experts compared the diagnosis and outcomes of high-risk patients who participated in the multicenter Cancer of Pancreas Screening-5 (CAPS5) study, in which the individuals underwent yearly imaging as part of the researchers’ surveillance. In the paper, experts concluded that patients who participate in such programs are more likely to have their pancreatic cancer detected in the earliest stages of development.
Pancreatic cancer is most often discovered after symptoms develop—most often in its more advanced stages. Therefore, it is critical to identify individuals who are at high-risk and would benefit from monitoring, says senior study author of the study Michael Goggins, MD, Sol Goldman Professor of Pancreatic Cancer Research and director of the Pancreatic Cancer Early Detection Laboratory.
“Many of those diagnosed with pancreatic cancer under surveillance can be potentially cured. By contrast, people who dropped off their surveillance had poor survival rates. Our results support the CAPS surveillance recommendation that those who meet the criteria should undergo regular screenings.”
A total of 1,461 patients were enrolled in the CAPS5 study between 2014 and 2021. Each individual was deemed high-risk due to either a genetic variant that made them more susceptible to pancreatic cancer or a first degree relative who had received a diagnosis. Once identified, the patients underwent one of several imaging exam options—endoscopic ultrasound, MRI or CT.
During this time, 10 patients were diagnosed with pancreatic ductal adenocarcinoma (PDAC), one of whom dropped out of the study and was diagnosed with metastatic disease four years later. Out of the nine patients who continued surveillance, seven were diagnosed with stage 1 disease, one with stage 2 and one with stage 3.
These results, combined with that of the entire CAPS cohort that was formed in 1998, indicate that annual imaging of high-risk individuals significantly increases five-year survival (73.3%) and overall survival (9.8 years vs 1.5 years for patients diagnosed outside surveillance).
“Our results support current CAPS surveillance recommendations and argue against the notion of limiting pancreatic surveillance to those high-risk individuals with known pathogenic mutations,” the experts added, though they did acknowledge that more research is needed to evaluate more conclusive methods of determining cancer risk. This could improve the cost-effectiveness of screening for a less common cancer like PDAC.