TOPLINE:
Surveillance of high-risk individuals may detect pancreatic ductal adenocarcinoma at an earlier stage, when the tumor is smaller and easier to treat, and could help improve survival in this population.
METHODOLOGY:
Pancreatic ductal adenocarcinoma has poor 5-year survival rates and is often detected at later stages. General population screening is not recommended, but high-risk individuals, such as those with familial or genetic predispositions, may benefit from regular surveillance.The Cancer of the Pancreas Screening (CAPS) program, initiated in 1998, has been evaluating the effectiveness of such targeted surveillance for over two decades, but whether targeted surveillance confers a survival benefit remains unclear.The current study evaluated 26 high-risk individuals in the CAPS program who were ultimately diagnosed with pancreatic ductal adenocarcinoma. These high-risk individuals had undergone surveillance with annual endoscopic ultrasonography or MRI prior to diagnosis.The researchers compared these 26 individuals with 1504 matched control patients with pancreatic ductal adenocarcinoma from the Surveillance, Epidemiology, and End Results (SEER) database. The high-risk individuals and SEER control patients were matched on age, sex, and year of diagnosis.The primary outcomes were tumor stage at diagnosis, overall survival, and pancreatic cancer-specific mortality.
TAKEAWAY:
High-risk individuals were significantly more likely to be diagnosed with early-stage pancreatic cancer ― 38.5% were diagnosed at stage I vs 10.3% in the general US population, and 30.8% were diagnosed at stage II vs 25.1% in the general US population (P <.001 median tumor size at diagnosis was smaller in high-risk individuals than control patients vs cm p and significantly fewer had distant metastases stage lived about years longer of months for ratio the with screen-detected cancer overall survival even higher months.the probability surviving better group a lower dying from pancreatic>IN PRACTICE:
Surveillance of high-risk individuals led to detection of “smaller pancreatic cancers, a greater number of patients with stage I disease,” as well as “a much higher likelihood of long-term survival than unscreened patients in the general population,” the authors concluded. “These findings suggest that selective surveillance of individuals at high risk for pancreatic cancer may improve clinical outcomes.”
SOURCE:
This study, with first author Amanda L. Blackford, from Johns Hopkins Medical Institutions, Baltimore, was published online on July 3 in JAMA Oncology.
LIMITATIONS:
The findings might have limited generalizability due to enrolment at academic referral centers, limited racial and ethnic diversity, and a small number of high-risk individuals progressing to pancreatic cancer. The study also lacked a control group of unscreened high-risk individuals.
DISCLOSURES:
This study was supported by the National Institutes of Health, Susan Wojcicki and Dennis Troper, and others. Several authors reported financial ties outside this work.
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