Identifying key factors for the effectiveness of pancreatic cancer screening: A model‐based analysis

• Published in: International journal of cancer Vol. 149; no. 2; pp. 337 - 346
• Main Authors: Koopmann, Brechtje D. M., Harinck, Femme, Kroep, Sonja, Konings, Ingrid C. A. W., Naber, Steffie K., Lansdorp‐Vogelaar, Iris, Fockens, Paul, Hooft, Jeanin E., Cahen, Djuna L., Ballegooijen, Marjolein, Bruno, Marco J., Kok, Inge M. C. M.
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 15.07.2021; Wiley Subscription Services, Inc
• Subjects: Cancer; Cancer screening; Cancer Therapy and Prevention; Magnetic resonance imaging; Medical prognosis; Medical research; Medical screening; microsimulation model; Mortality; Pancreatic cancer; screening; Sensitivity analysis; Surgery; Surveillance; pancreatic cancer; screening; microsimulation model
• ISSN: 0020-7136; 1097-0215
• DOI: 10.1002/ijc.33540

Pancreatic cancer (PC) survival is poor, as detection usually occurs late, when treatment options are limited. Screening of high‐risk individuals may enable early detection and a more favorable prognosis. Knowledge gaps prohibit establishing the effectiveness of screening. We developed a Microsimulation Screening Analysis model to analyze the impact of relevant uncertainties on the effect of PC screening in high‐risk individuals. The model simulates two base cases: one in which lesions always progress to PC and one in which indolent and faster progressive lesions coexist. For each base case, the effect of annual and 5‐yearly screening with endoscopic ultrasonography/magnetic resonance imaging was evaluated. The impact of variance in PC risk, screening test characteristics and surgery‐related mortality was evaluated using sensitivity analyses. Screening resulted in a reduction of PC mortality by at least 16% in all simulated scenarios. This reduction depended strongly on the natural disease course (annual screening: −57% for “Progressive‐only” vs −41% for “Indolent Included”). The number of screen and surveillance tests needed to prevent one cancer death was impacted most by PC risk. A 10% increase in test sensitivity reduced mortality by 1.9% at most. Test specificity is important for the number of surveillance tests. In conclusion, screening reduces PC mortality in all modeled scenarios. The natural disease course and PC risk strongly determines the effectiveness of screening. Test sensitivity seems of lesser influence than specificity. Future research should gain more insight in PC pathobiology to establish the true value of PC screening in high‐risk individuals. What's new? About 10 percent of pancreatic cancers occur in individuals with inherited risk factors. While screening such high‐risk individuals can facilitate the detection of precursor lesions and early‐stage cancer, the extent to which benefits outweigh harms, including overdiagnosis, remains unknown. Here, using a microsimulation model, the authors explored uncertainties concerning the early detection of pancreatic cancer and analyzed the impact of these uncertainties on the effect of screening. In all simulated scenarios, screening was associated with reduced pancreatic cancer mortality. The effectiveness of screening was most strongly impacted by characteristics of natural disease course and level of pancreatic cancer risk