Screening and Surveillance of Individuals at High Risk for Pancreatic Cancer: Where are We now?

Review Article

Screening and Surveillance of Individuals at High Risk for Pancreatic Cancer: Where are We now?

Femme Harinck, Jan‐Werner Poley and Marco J Bruno

Affiliation:  Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, the Netherlands


ABSTRACT

Pancreatic cancer (PC) is one of the most fatal of all malignancies. The median survival after diagnosis is 6 months. The overall 5‐year survival is less than 5%. Despite improvements in imaging and surgical techniques, survival statistics have hardly improved over the past decades. Resection offers the only chance for cure, but due to early vascular involvement and/or metastatic spread, only a minority (10–20%) of symptomatic patients are eligible for surgery. Sadly, even after resection, the outcome in these patients is disappointingly low with a 5‐year survival of only 10–30%. Consequently, to improve this dismal outlook, it would be desirable to detect small asymptomatic early cancers or, more preferably, precursor lesions at the time when the disease is still at a curable stage. Well‐defined precursor lesions of pancreatic cancer include pancreatic intraepithelial neoplasm (PanIN) and intraductal papillary mucinous neoplasia (IPMN). Detection and resection of these lesions before they turn malignant might improve survival. Because of the relatively low incidence of the disease and the lack of accurate, inexpensive, and non‐invasive diagnostic tests for detection, screening of the general population is not realistic. However, screening might be feasible in a well‐defined population of individuals at high risk for this fatal disease. Here, we summarize the current status of pancreatic cancer screening and surveillance in high‐risk individuals.

Keywords: familial pancreatic cancer, pancreatic cancer susceptibility, surveillance and screening

Correspondence: Jan‐Werner Poley, Erasmus MC, University Medical Center Rotterdam, Department of Gastroentreology and Hepatology, ’s Gravendijkwal 230, CE Rotterdam, the Netherlands. Tel: (31)‐10‐70‐3015; Fax: (31)‐10‐703‐4682; e‐mail: j.poley@erasmusmc.nl