There is insufficient data demonstrating improved outcome to recommend routine screening of individuals at high familial risk. However, there is accumulating evidence that screening may detect pre-invasive lesions which may allow for early intervention.
Cancer of the Pancreas (CAPS) high risk surveillance study of 354 patients reported neoplastic progression (defined as development of pancreatic cancer or high-grade precursor lesion) in 7% of patients over a 16 year period.r Within the 354 patients, 297 were from familial pancreatic cancer families, and neoplastic progression was detected in 6.7% (20 of 297). 9 out of the 10 surveillance detected cancers were diagnosed at a clinically resectable stage. 4 pancreatic cancers developed outside surveillance (these patients either stopped or were late for surveillance), and only 1 had resectable disease.
The International CAPS Consortium favours annual endoscopic US or MRI/MR cholangiopancreatography for pancreatic imaging, particularly as they do not involve ionising radiation.r Endoscopic ultrasound also allows for the collection of samples to identify precursor lesions.
Recent surveillance studies have shown that the majority of clinically significant lesions are age related. Canto et al. 2018 reported that most pancreatic ductal adenocarcinomas were identified in individuals aged >55 years and that those detected at a younger age had a family history of early onset pancreatic cancer.r Bartsch et al. 2016 also found the most relevant lesions in those aged >50 years.r CAPS Consortium agreed that surveillance should start no earlier than age 50, or 10 years earlier than the youngest diagnosis of pancreatic cancer.r