Annual pancreatic cancer screening was sufficient for high, moderate risk patients

Issue: June 25, 2012

SAN DIEGO — In patients who were compliant with pancreatic cancer screening recommendations, interval screening up to 4 years revealed no lesions within one year of initial assessment that prompted a change in management, according to data presented at the 2012 Digestive Disease Week Annual Meeting.

While up to 15% of pancreatic cancer patients have a positive family history or syndromic predisposition, and screening for pancreatic cancer is offered to high-risk families, the optimal interval for this type of screening remains unknown. According to researchers, frequent screening may unnecessarily highlight benign lesions, while infrequent screening may miss growth of concerning lesions.

To determine if concerning lesions develop during follow-up intervals, Sheila Kumar, MD, and colleagues from the division of digestive and liver diseases in the department of medicine at Columbia University in New York City, enrolled patients into a screening program at a single, large referral center.

“In recent years, we have discovered that screening and surveillance for patients who are at high-risk for pancreatic cancer is a benefit – we are picking things up that are potentially life-saving,” Kumar told HemOnc Today. “The question, however, is how often should you be screening these patients? At present there is no set interval – should intervals be every six months, every year, or simply based on the level of risk? Screening guidelines are not really established for this specific patient group.”

At the initial visit, patients were categorized as high, moderate, or average risk of developing pancreatic cancer, based on number of family members with pancreatic cancer or associated genetic syndromes, as previously published. Magnetic resonance imaging and/or endoscopic ultrasound were offered as baseline studies and at intervals of 6-12 months, based on risk category and age.

According to the study results, of the 61 patients who underwent follow-up imaging up to 4 years after initial evaluation, only 26.2% (16/61) had changes of any kind. Of these patients, 6.5% had concerning changes, including the growth of a cystic lesion, new mass lesion or progressive parenchymal or ductal lesions.

“We found that that even within the high-risk, moderate-risk, and average-risk populations, there was no significant difference between the frequencies of the changes that we were discovering, including changes in the endoscopic ultrasound that ranged from no change to a significant change or from a significant change to a resolution of that change,” Kumar said.

A new pancreatic cancer and an increase in size of a known neuroendocrine tumor were found after 4 years in 2 high-risk patients who did not present for follow-up despite extensive efforts, which made it impossible to determine when these changes would have been noted on imaging.

In the study cohort, 8.2% of the patients exhibited non-specific changes, including hyperechoic stranding, echogenicity, or atrophy. One patient exhibited changes after 6 months, while the remaining 4 displayed changes noted after 2-4 years. Another 11.5% of the patient cohort had changes consisting of resolution of previous abnormalities, including decrease in size of intraductal papillary mucinous neoplasms and cystic lesions.

In addition, high-risk patients had a greater frequency of new findings but this was not statistically significant: 22.2% average-risk patients vs. 18.8% moderate-risk patients vs. 50% high-risk patients (P=0.11).

“There was no significant difference among changes within the three risk categories, and our study cohort did not identify anything within a year of screening,” said Kumar. “Even for patients who are at high-risk, doctors could potentially push their screening interval out to a year so they do not necessarily need to be performing endoscopic ultrasounds or imaging on these patients every three months or six months as others are doing.”

Disclosure: Dr. Hwang has received grant/research support from UCB, Inc. and Dr. Frucht has a speaking/teaching position with Takeda Pharmaceutical Company Ltd.

For more information:

Kumar S. #Su1821: Interval Follow-up of High-Risk Pancreatic Cancer Screening Patients Demonstrates No Significant Lesions Within One Year. Presented at: the 2012 Digestive Disease Week Annual Meeting; May 19-22, 2012; San Diego.