Authors: Ellen Clarke
According to a recent report published by JAMA Surgery, pancreatic lesions were identified in 40% of high-risk patients who took part in MRI screening program – five of whom required surgery.
Incidence and mortality rates are almost equal for pancreatic cancer, and it is a leading cause of cancer death. Currently approximately 30% of patients with pancreatic ductal adenocarcinoma undergo surgery and the 5-year survival rate is below 20%. According to the study, in approximately 10% of patients it is possible to find a family history of pancreatic cancer.
Researchers from the Karolinska Institute (Stockholm, Sweden) led by Marco Del Chiaro analyzed results from an MRI-based screening program for patients with a genetic risk of developing pancreatic cancer.
The study included 24 women and 16 men, with an average age of nearly 50 years. In 38 of these patients, increased risk of the disease was based on family history. The study identified BRCA2, BRCA1 and p16 gene mutations in some patients. The average study follow-up was 12.9 months, with MRI screening repeated after 1 year if the initial screen was negative or at 6 months if there were unspecific findings or findings that did not indicate surgery.
Screening identified a pancreatic lesion in 40% of patients. Of these patients 35% had intraductal papillary mucinous neoplasia, which can become invasive, and 5% of patients had pancreatic ductal adenocarcinoma. Twelve and a half percent of patients underwent surgery, and the remaining patients continued to be monitored.
“An MRI-based protocol for the surveillance of individuals at risk for developing pancreatic cancer seems to detect cancer or premalignant lesions with good accuracy. The exclusive use of MRI can reduce costs, increase availability and guarantee the safety of the individuals under surveillance compared with protocols that are based on more aggressive methods. However, because of the small number of patients and the divergent results, this study did not allow evaluation of the efficacy of MRI as a single screening modality,” the authors of the study concluded.
In a related commentary, Mark S Talamonti from North Shore University Health System (IL, USA) wrote: “Pancreatic cancer is diagnosed in only 10% of patients with syndromic risk factors or a family history of pancreatic cancer. The other 90% are considered sporadic cancers with no currently known risk factors. And that is the real challenge for the future of early detection of pancreatic cancer. In current clinical practice, no biomarkers exist for diagnosing early-stage disease. Population screening with radiographic imaging or endoscopic procedures makes no clinical or economic sense for a cancer that represent only 3% of estimated new cancers each year; however, with an aging population, this most formidable of human cancers will only increase in incidence and frequency. There is a clear and unequivocal need for affordable screening strategies based on reliable biomarkers and efficient imaging modalities.”
Source: JAMA Surgery press release