A Community-Based Pancreatic Cancer Screening Study in High-Risk Individuals: Preliminary Efficacy and Safety Results

Jonathan Kandiah, Tammy Lo, Dugho Jin, Landon Melchior, Thorsten L Krebs, Naveen Anand, Susan Ingram, Pramila Krumholtz, Deep Pandya, Antolin Trinidad, Xiang Eric Dong, Ramanathan Seshadri, James Bauman, Ronald Lee, Richard C Frank, Jonathan Kandiah, Tammy Lo, Dugho Jin, Landon Melchior, Thorsten L Krebs, Naveen Anand, Susan Ingram, Pramila Krumholtz, Deep Pandya, Antolin Trinidad, Xiang Eric Dong, Ramanathan Seshadri, James Bauman, Ronald Lee, Richard C Frank

Abstract

Introduction: Pancreatic cancer (PC) screening recommendations have been based on studies performed solely at high-volume academic centers. To make PC screening more widely available, community-based efforts are essential. We implemented a prospective PC screening study in the community of Fairfield County, CT, and report our early safety and efficacy results.

Methods: Eligible individuals were enrolled into an investigator-initiated study and underwent a baseline and 3 annual magnetic resonance imagings/magnetic resonance cholangiopancreatographies (MRIs/MRCPs) with gadolinium, biannual blood donations for biobanking, and assessments for anxiety and depression. All MRIs were presented at a multidisciplinary board to determine whether further investigation was warranted.

Results: Seventy-five individuals have been enrolled and 201 MRIs performed over a 2.6-year average length of follow-up. Abnormal pancreatic findings (predominantly small cysts) were detected in 58.7% of the participants. Among these, 6.7% underwent endoscopic ultrasound, with 1 case complicated by postprocedural pancreatitis. One surgical resection was performed on a 4.7-cm intraductal papillary mucinous neoplasm with a focus on low-grade pancreatic intraepithelial neoplasia. One incidental finding of fibrosing mediastinitis was detected. Anxiety and depression scores decreased over the course of this study from 21.4% to 5.4% and 10.7% to 3.6%, respectively.

Discussion: This preliminary report supports the feasibility of performing MRI/magnetic resonance cholangiopancreatographies-based PC screening as part of a clinical trial in a community setting. A longer follow-up is needed to better assess safety and efficacy. To the best of our knowledge, this is the first report from a community-based PC screening effort ( clinicaltrials.gov ID: NCT03250078).

Conflict of interest statement

Guarantor of the article: Richard C. Frank, MD.

Specific author contributions: J.K.: drafting and editing the manuscript and interpreting data. T.L.: study planning and design, collecting and interpreting data, and writing the manuscript. D.J.: collecting and interpreting data and writing the manuscript. L.M.: interpreting data. T.L.K.: interpreting data. N.A.: collecting and interpreting data and writing and editing the manuscript. S.I.: collecting and interpreting data and editing the manuscript. P.K.: collecting data and editing the manuscript. D.P.: interpreting data, performed data analysis, and writing and editing the manuscript. A.T.: collecting and interpreting data and writing and editing the manuscript. X.D.: interpreting data and editing the manuscript. R.S.: interpreting data and editing the manuscript. J.B.: collecting and interpreting data and editing the manuscript. R.L.: collecting and interpreting data and editing the manuscript. R.C.F.: conceived and designed the study, collected and interpreted data, performed analysis, and contributed to writing and editing the manuscript.

Financial support: This work was supported by a Tribute to Pamela/The Naughton Family Fund, the Rallye for Pancreatic Cancer, and the Cornelia T. Bailey Foundation.

Potential competing interests: None to report.

Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.

Figures

Figure 1.
Figure 1.
Consort diagram EUS, endoscopic ultrasound.
Figure 2.
Figure 2.
Breakdown of pancreatic findings, identified on screening MRI. EUS: endoscopic ultrasound; FNA: fine-needle aspiration.
Figure 3.
Figure 3.
Depression and anxiety scores over time. (a) Shows the change in anxiety scores over time of the participants with baseline normal and elevated anxiety scores. (b) Shows the change in depression scores over time of the participants with baseline normal and elevated depression scores. For both anxiety and depression groups, the fraction of participants with elevated scores had declined over the study duration when compared with baseline.

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