Individuals at high risk for pancreatic cancer should at minimum be considered for screening for the disease, according to a new clinical practice update from the American Gastroenterological Association (AGA).
The update also defines what constitutes “high risk” for pancreatic cancer, when and how screenings should occur, and the role of genetic testing as well as counseling.
An expert review of published reports on pancreatic cancer screening studies in high-risk individuals yielded 13 best practice advice recommendations – published in Gastroenterology (online May 13, 2020; doi:10.1053/j.gastro.2020.03.088).
Screening should considered for patients determined to be at “high risk,” including those who have first-degree relatives with pancreatic cancer with at least two affected genetically-related relatives.
Additionally, screening should be considered in patients with genetic syndromes or genetic mutations associated with an increased risk of disease, including Peutz-Jeghers syndrome, hereditary pancreatitis, and mutations in BRCA1/2, PALB2, and ATM, among others. The expert panel noted that genetic testing and counseling should be considered for familial pancreatic cancer relatives who are eligible for surveillance.
High-risk individuals should be screening at age 50 years or 10 years younger than the initial age of familial onset, according to the update. However, screening should be initiated at age 40 years in CKDN2A and PRSS1 mutation carriers with hereditary pancreatitis and at age 35 years for those with Peutz-Jeghers syndrome.
Furthermore, the update states that decisions regarding therapy directed towards abnormal findings detected during screening should be made by a dedicated multidisciplinary team together with the high-risk individual and his/her family.
Clinicians should consider discontinuing pancreatic cancer screening in high-risk individuals when they are likely to die of non-pancreatic cancer-related causes.
Lastly, surgical resection should be performed at high-volume centers, the update states.—Zachary Bessette