International Cancer of the Pancreas Screening (CAPS) Consortium summit on the management of patients with increased risk for familial pancreatic cancer

• Published in: Gut Vol. 62; no. 3; pp. 339 - 347
• Main Authors: Canto, Marcia Irene, Harinck, Femme, Hruban, Ralph H, Offerhaus, George Johan, Poley, Jan-Werner, Kamel, Ihab, Nio, Yung, Schulick, Richard S, Bassi, Claudio, Kluijt, Irma, Levy, Michael J, Chak, Amitabh, Fockens, Paul, Goggins, Michael, Bruno, Marco
• Format: Journal Article Conference Proceeding
• Language: English
• Published: England BMJ Publishing Group Ltd and British Society of Gastroenterology 01.03.2013; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Age Factors; Carcinoma - diagnosis; Carcinoma - genetics; Carcinoma - surgery; Cholangiopancreatography, Magnetic Resonance; Consortia; Early Detection of Cancer; Endoscopic Ultrasonography; Endoscopy; Endosonography; Family Cancer; Family medical history; Follow-Up Studies; Genetic Predisposition to Disease; Guidelines; Humans; Mutation - genetics; Neoplasm Grading; Pancreatectomy - standards; Pancreatic Cancer; Pancreatic Neoplasms - diagnosis; Pancreatic Neoplasms - genetics; Pancreatic Neoplasms - surgery; Pedigree; Risk Factors; Screening; Studies; Surveillance; Treatment Outcome; Tumors
• ISSN: 0017-5749; 1468-3288
• DOI: 10.1136/gutjnl-2012-303108

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.