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Early detection and treatment may prevent pancreatic cancer in those at high-risk
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Digestive Disease Week 2008
People with a family history of pancreatic cancer may benefit from surveillance with a combination of endoscopic procedures to detect pancreatic neoplasia, according to data presented at Digestive Disease Week 2008.
“Pancreatic cancer is diagnosable at the pre-invasive stage, and early detection can cure impending pancreatic cancer,” said Michael D. Saunders, MD, a clinical associate professor of medicine at the University of Washington. “Until genetic markers are identified, imaging tests remain the mainstay of evaluation for high-risk patients.”
At least 10% of pancreatic cancer is inherited, Saunders said. He and colleagues followed 100 patients in 73 families for 10 years. The patients either had two or more family members with pancreatic cancer, one of whom was a first-degree relative, or they had a gene associated with a lifetime risk for pancreatic cancer of 15% or more
They performed endoscopic ultrasound at baseline and then annually. Patients with an abnormal ultrasound underwent endoscopic retrograde cholangiopancreatography (ERCP). Those who also had an abnormal ERCP were given the option to provide pancreatic tissue for histologic diagnosis. Those with a strong family history of the disease and evidence of advanced pancreatic neoplasia were given the option of pancreatectomy.
Two of the patients developed cancer and 20 developed advanced pancreatic neoplasia. On the initial exam, 52 patients had an abnormal ultrasound. Ten patients who initially had a normal ultrasound developed abnormal changes. Four had abnormal ERCP findings then had surgical intervention.
The patients with pancreatic cancer developed masses at years one and four after starting surveillance. None of the patients with advanced pancreatic neoplasia who had pancreatectomy developed pancreatic cancer during a seven-year follow-up. – by Emily Shafer
For more information:
- Saunders MD, Byrd DR, Bronner MP, et al. #644. Surveillance and natural history of high risk patients who inherit pancreatic cancer. Presented at: Digestive Disease Week 2008; May 17-22; San Diego.