Management of patients with increased risk for familial pancreatic cancer: updated recommendations from the International Cancer of the Pancreas Screening (CAPS) Consortium
Michael Goggins, Kasper Alexander Overbeek, Randall Brand, Sapna Syngal, Marco Del Chiaro, Detlef K Bartsch, Claudio Bassi, Alfredo Carrato, James Farrell, Elliot K Fishman, Paul Fockens, Thomas M Gress, Jeanin E van Hooft, R H Hruban, Fay Kastrinos, Allison Klein, Anne Marie Lennon, Aimee Lucas, Walter Park, Anil Rustgi, Diane Simeone, Elena Stoffel, Hans F A Vasen, Djuna L Cahen, Marcia Irene Canto, Marco Bruno, International Cancer of the Pancreas Screening (CAPS) consortium, Paolo Giorgio Arcidiacono, Reiko Ashida, Margreet Ausems, Marc Besselink, Katharina Biermann, Bert Bonsing, Teri Brentnall, Amitabh Chak, Dayna Early, Carloz Fernandez-Del Castillo, Harold Frucht, Toru Furukawa, Steven Gallinger, Jennifer Geurts, Bas Groot Koerkamp, Pascal Hammel, Frederik Hes, Julio Iglesias-Garcia, Ihab Kamel, Masayuki Kitano, Günter Klöppel, Nanda Krak, Robert Kurtz, Richard Kwon, Jesse Lachter, Jeffrey Lee, Michael Levy, Giuseppe Malleo, Cheryl Meguid, Anirban Maitra, Daniel Margolis, Johan Offerhaus, Sara Olson, Salvatore Paiella, Walter Park, Gloria Petersen, Jan-Werner Poley, Francisco X Real, John Saltzman, Richard Schulick, Alina Stoita, Kyoichi Takaori, Masao Tanaka, Eric Tamm, Mark Topazian, Enrique Vazquez-Sequeiros, Frank Vleggaar, Wouter De Vos Tot Nederveen Cappel, Charles Yeo, Martin Wasser, Anja Wagner, Michael Wallace, Christopher Wolfgang, Laura Wood, Michael Goggins, Kasper Alexander Overbeek, Randall Brand, Sapna Syngal, Marco Del Chiaro, Detlef K Bartsch, Claudio Bassi, Alfredo Carrato, James Farrell, Elliot K Fishman, Paul Fockens, Thomas M Gress, Jeanin E van Hooft, R H Hruban, Fay Kastrinos, Allison Klein, Anne Marie Lennon, Aimee Lucas, Walter Park, Anil Rustgi, Diane Simeone, Elena Stoffel, Hans F A Vasen, Djuna L Cahen, Marcia Irene Canto, Marco Bruno, International Cancer of the Pancreas Screening (CAPS) consortium, Paolo Giorgio Arcidiacono, Reiko Ashida, Margreet Ausems, Marc Besselink, Katharina Biermann, Bert Bonsing, Teri Brentnall, Amitabh Chak, Dayna Early, Carloz Fernandez-Del Castillo, Harold Frucht, Toru Furukawa, Steven Gallinger, Jennifer Geurts, Bas Groot Koerkamp, Pascal Hammel, Frederik Hes, Julio Iglesias-Garcia, Ihab Kamel, Masayuki Kitano, Günter Klöppel, Nanda Krak, Robert Kurtz, Richard Kwon, Jesse Lachter, Jeffrey Lee, Michael Levy, Giuseppe Malleo, Cheryl Meguid, Anirban Maitra, Daniel Margolis, Johan Offerhaus, Sara Olson, Salvatore Paiella, Walter Park, Gloria Petersen, Jan-Werner Poley, Francisco X Real, John Saltzman, Richard Schulick, Alina Stoita, Kyoichi Takaori, Masao Tanaka, Eric Tamm, Mark Topazian, Enrique Vazquez-Sequeiros, Frank Vleggaar, Wouter De Vos Tot Nederveen Cappel, Charles Yeo, Martin Wasser, Anja Wagner, Michael Wallace, Christopher Wolfgang, Laura Wood
Abstract
Background and aim: The International Cancer of the Pancreas Screening Consortium met in 2018 to update its consensus recommendations for the management of individuals with increased risk of pancreatic cancer based on family history or germline mutation status (high-risk individuals).
Methods: A modified Delphi approach was employed to reach consensus among a multidisciplinary group of experts who voted on consensus statements. Consensus was considered reached if ≥75% agreed or disagreed.
Results: Consensus was reached on 55 statements. The main goals of surveillance (to identify high-grade dysplastic precursor lesions and T1N0M0 pancreatic cancer) remained unchanged. Experts agreed that for those with familial risk, surveillance should start no earlier than age 50 or 10 years earlier than the youngest relative with pancreatic cancer, but were split on whether to start at age 50 or 55. Germline ATM mutation carriers with one affected first-degree relative are now considered eligible for surveillance. Experts agreed that preferred surveillance tests are endoscopic ultrasound and MRI/magnetic retrograde cholangiopancreatography, but no consensus was reached on how to alternate these modalities. Annual surveillance is recommended in the absence of concerning lesions. Main areas of disagreement included if and how surveillance should be performed for hereditary pancreatitis, and the management of indeterminate lesions.
Conclusions: Pancreatic surveillance is recommended for selected high-risk individuals to detect early pancreatic cancer and its high-grade precursors, but should be performed in a research setting by multidisciplinary teams in centres with appropriate expertise. Until more evidence supporting these recommendations is available, the benefits, risks and costs of surveillance of pancreatic surveillance need additional evaluation.
Keywords: early detection; familial pancreatic cancer; genetic predisposition; pancreatic ductal adenocarcinoma; surveillance.
Conflict of interest statement
Competing interests: The authors disclose the following: JEvH received research funding from Abbott and Cook Medical; she is a consultant to Boston Scientific, Cook Medical, and Medtronics. DLC is a consultant to Tramedico. MB received research funding from Boston Scientific, Cook Medical, Pentax Medical, 3M; he is a consultant to Boston Scientific, Cook Medical, Pentax Medical, Mylan, MediRisk, and Medicom. PF is a consultant to Olympus, Cook Medical, Ethicon Endosurgery and received research funding from Boston Scientific. RB has received research funding from Immunovia and Freenome. MIC received research funding from Pentax C2 Cryoballoon and Endogastric Solutions. DS received research funding from Immunovia, Sanofi and Tempus; she is on the Scientific Advisory Board for Nybo Therapeutics, Interpace and Tyme.
© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.
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Source: PubMed