Short-term Results of a Magnetic Resonance Imaging–Based Swedish Screening Program for Individuals at Risk for Pancreatic Cancer

• Published in: JAMA surgery Vol. 150; no. 6; pp. 512 - 518
• Main Authors: Del Chiaro, Marco, Verbeke, Caroline S, Kartalis, Nikolaos, Pozzi Mucelli, Raffaella, Gustafsson, Peter, Hansson, Johan, Haas, Stephan L, Segersvärd, Ralf, Andren-Sandberg, Åke, Löhr, J.-Matthias
• Format: Journal Article
• Language: English
• Published: United States American Medical Association 01.06.2015
• Subjects: Adult; Aged; Bacteriocins; Carcinoma, Pancreatic Ductal - genetics; Carcinoma, Pancreatic Ductal - prevention & control; Early Detection of Cancer - methods; Early Detection of Cancer - statistics & numerical data; Female; Genes, BRCA1 - physiology; Genes, BRCA2 - physiology; Genetic Predisposition to Disease; Humans; Magnetic Resonance Imaging; Male; Mass Screening - methods; Medicin och hälsovetenskap; Middle Aged; Pancreatectomy; Pancreatic Neoplasms - genetics; Pancreatic Neoplasms - prevention & control; Pancreatic Neoplasms - surgery; Peptides; Precancerous Conditions - diagnosis; Prospective Studies; Sweden; Sweden
• ISSN: 2168-6254; 2168-6262; 2168-6262
• DOI: 10.1001/jamasurg.2014.3852

IMPORTANCE: Pancreatic cancer is the fourth leading cause of cancer-related death in Western countries. In approximately 10% of all patients with pancreatic cancer, it is possible to define a positive family history for pancreatic cancer or for one of the other related genetic syndromes. A screening program for individuals at risk is recommended; however, surveillance modalities have not been defined yet. OBJECTIVE: To analyze the short-term results of a prospective clinical surveillance program for individuals at risk for pancreatic cancer using a noninvasive magnetic resonance imaging (MRI)–based screening protocol. DESIGN, SETTING AND PARTICIPANTS: A prospective observational study of all patients with a genetic risk for developing pancreatic cancer who were referred to Karolinska University Hospital between January 1, 2010, and January 31, 2013, using an MRI-based surveillance program. All patients were investigated for the most common genetic mutations associated with pancreatic cancer. EXPOSURE: A noninvasive MRI-based screening protocol. MAIN OUTCOMES AND MEASURES: The ability of MRI to identify potential precancerous or early cancers in individuals at risk for pancreatic cancer. RESULTS: Forty patients (24 women and 16 men) were enrolled. The mean age was 49.9 years. The mean length of follow-up was 12.9 months. The numbers of relatives affected by pancreatic cancer were 5 in 2 patients (5%), 4 in 5 patients (12.5%), 3 in 17 patients (42.5%), 2 in 14 patients (35%), and 1 in 2 patients (5%). In 4 patients (10%), a p16 mutation was found; in 3, a BRCA2 mutation (7.5%); and in 1, a BRCA1 mutation (2.5%). In 16 patients (40%), MRI revealed a pancreatic lesion: intraductal papillary mucinous neoplasia (14 patients, 35%) and pancreatic ductal adenocarcinoma (2 patients, 5%). One patient had a synchronous intraductal papillary mucinous neoplasia and pancreatic ductal adenocarcinoma. Five patients (12.5%) required surgery (3 for pancreatic ductal adenocarcinoma and 2 for intraductal papillary mucinous neoplasia), while the remaining 35 are under continued surveillance. CONCLUSIONS AND RELEVANCE: During a median follow-up of approximately 1 year, pancreatic lesions were detected in 40% of the patients, of whom 5 underwent surgery. Although the study time was relatively short, the surveillance program in individuals at risk seems to be effective.