JAMA: 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. A magnetic resonance imaging (MRI)-based screening program for
individuals at high risk (family history) of pancreatic cancer identified pancreatic
lesions in 16 of 40 (40 percent) of patients, of whom 5 five underwent
surgery, according to a report published online by JAMA Surgery. Pancreatic cancer is a leading cause of cancer death and can be
considered a global lethal disease because incidence and mortality rates
are nearly identical. Although treatment has improved, the surgery rate
in patients with ductal adenocarcinoma is around 30 percent and the
five-year survival rate is less than 20 percent. In about 10 percent of
all patients with pancreatic cancer, it is possible to find a family
history, according to the study background.
Marco Del Chiaro, M.D., Ph.D., of the Karolinska Institute,
Stockholm, Sweden, and coauthors analyzed short-term results from an
MRI-based screening program for patients with a genetic risk of
developing pancreatic cancer.
The study included 40 patients (24 women and 16 men with an average
age of nearly 50). In 38 of the patients, increased risk of the disease
was based on family history of pancreatic cancer. BRCA2, BRCA1 and p16
gene mutations were identified in some patients. The average study
follow-up was 12. 9 months, with MRI screening repeated after one year
if the initial screen was negative or at six months if there were
unspecific findings or findings that did not indicate surgery.
According to the results, MRIs found a pancreatic lesion in 16
patients (40 percent): intraductal papillary mucinous neoplasia, which
can become invasive cancer, in 14 patients (35 percent) and pancreatic
ductal adenocarcinoma in two patients (5 percent). Five patients (12.5
percent) required surgery (3 for pancreatic ductal adenocarcinoma and 2
for intraductal papillary mucinous neoplasia), the remaining 35 continue
under surveillance.
“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 study concludes.
(JAMA Surgery. Published online April 8, 2015. doi:10.1001/jamasurg.2014.3852. Available pre-embargo to the media at http://media.jamanetwork.com.)
Editor’s Note:
Please see the article for additional information, including other
authors, author contributions and affiliations, financial disclosures,
funding and support, etc.
Commentary: Screening Strategies for Pancreatic Cancer in High-Risk Patients
In a related commentary, Mark S. Talamonti, M.D., of the NorthShore
University HealthSystem, Evanston, Ill., writes: “Pancreatic cancer is
diagnosed in only 10 percent of patients with syndromic risk factors or a
family history of pancreatic cancer. The other 90 percent 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 percent 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.”
(JAMA Surgery. Published online April 8, 2015. doi:10.1001/jamasurg.2015.0391. Available pre-embargo to the media at http://media.jamanetwork.com.)
Editor’s Note:
Please see the article for additional information, including other
authors, author contributions and affiliations, financial disclosures,
funding and support, etc.