Pancreatic cancer surveillance and its ongoing challenges: is it time to refine our eligibility criteria?
Thomas P Potjer
Individuals at high risk for pancreatic cancer (PC) could potentially benefit from regular surveillance, as the first clinical symptoms of PC often appear only at an advanced stage, at which point the prognosis is often dismal. PC surveillance is therefore aimed at the timely detection and surgical resection of still curable lesions in usually asymptomatic patients. In a guideline developed by the International Cancer of the Pancreas Screening (CAPS) Consortium, high-risk individuals (HRIs) eligible for surveillance are defined as those with either a strong family history of PC (familial pancreatic cancer; FPC) or those with a germline mutation in a high-risk PC susceptibility gene such as CDKN2A, STK11 or BRCA2. The preferred imaging modality is endoscopic ultrasound (EUS) and/or MRI/magnetic resonance cholangiopancreatography (MRCP).1 2 In a series of mostly small and short-term studies published since the early 2000s, the diagnostic yield of PC surveillance varied widely.2 However, more recent, larger studies with long-term follow-up have found evidence of increased survival among CDKN2A mutation carriers3 and HRIs from FPC families,4 thereby supporting continued PC surveillance of HRIs in a research setting.
In Gut, Overbeek et al 5 now report the yield of long-term surveillance in one of the largest cohorts of HRIs to date (n=366). A major strength of the study design was the routine genetic counselling and testing of individuals prior to enrollment, which allowed the authors to compare the yield of surveillance between HRIs.