International Cancer of the Pancreas Screening (CAPS) Consortium Summit on the Management of Patients With Increased Risk for Familial Pancreatic Cancer

Gut. 2013 Mar;62(3):339-47. doi: 10.1136/gutjnl-2012-303108. Epub 2012 Nov 7.

Abstract

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, BRCA2 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.

Publication types

  • Consensus Development Conference
  • Practice Guideline
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Carcinoma / diagnosis*
  • Carcinoma / genetics
  • Carcinoma / surgery
  • Cholangiopancreatography, Magnetic Resonance
  • Early Detection of Cancer
  • Endosonography
  • Follow-Up Studies
  • Genetic Predisposition to Disease*
  • Humans
  • Mutation / genetics
  • Neoplasm Grading
  • Pancreatectomy / standards*
  • Pancreatic Neoplasms / diagnosis*
  • Pancreatic Neoplasms / genetics
  • Pancreatic Neoplasms / surgery
  • Pedigree
  • Risk Factors
  • Treatment Outcome

Supplementary concepts

  • Pancreatic carcinoma, familial