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Screening for Pancreatic CancerUS Preventive Services Task Force Reaffirmation Recommendation Statement

Educational Objective
To review the US Preventive Services Task Force (USPSTF) recommendations regarding screening for pancreatic cancer.
1 Credit CME
Abstract

Importance  Pancreatic cancer is an uncommon cancer with an age-adjusted annual incidence of 12.9 cases per 100 000 person-years. However, the death rate is 11.0 deaths per 100 000 person-years because the prognosis of pancreatic cancer is poor. Although its incidence is low, pancreatic cancer is the third most common cause of cancer death in the United States. Because of the increasing incidence of pancreatic cancer, along with improvements in early detection and treatment of other types of cancer, it is estimated that pancreatic cancer may soon become the second-leading cause of cancer death in the United States.

Objective  To update the 2004 US Preventive Services Task Force (USPSTF) recommendation on screening for pancreatic cancer.

Evidence Review  The USPSTF reviewed the evidence on the benefits and harms of screening for pancreatic cancer, the diagnostic accuracy of screening tests for pancreatic cancer, and the benefits and harms of treatment of screen-detected or asymptomatic pancreatic cancer.

Findings  The USPSTF found no evidence that screening for pancreatic cancer or treatment of screen-detected pancreatic cancer improves disease-specific morbidity or mortality, or all-cause mortality. The USPSTF found adequate evidence that the magnitude of the benefits of screening for pancreatic cancer in asymptomatic adults can be bounded as no greater than small. The USPSTF found adequate evidence that the magnitude of the harms of screening for pancreatic cancer and treatment of screen-detected pancreatic cancer can be bounded as at least moderate. The USPSTF reaffirms its previous conclusion that the potential benefits of screening for pancreatic cancer in asymptomatic adults do not outweigh the potential harms.

Conclusions and Recommendation  The USPSTF recommends against screening for pancreatic cancer in asymptomatic adults. (D recommendation)

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Article Information

Corresponding Author: Douglas K. Owens, MD, MS, Stanford University, 616 Serra St, Encina Hall, Room C336, Stanford, CA 94305-6019 (chair@uspstf.net).

Correction: This article was corrected on October 11, 2019, for incorrect information in an author affiliation.

Accepted for Publication: June 26, 2019.

The US Preventive Services Task Force (USPSTF) members: Douglas K. Owens, MD, MS; Karina W. Davidson, PhD, MASc; Alex H. Krist, MD, MPH; Michael J. Barry, MD; Michael Cabana, MD, MA, MPH; Aaron B. Caughey, MD, PhD; Susan J. Curry, PhD; Chyke A. Doubeni, MD, MPH; John W. Epling Jr, MD, MSEd; Martha Kubik, PhD, RN; C. Seth Landefeld, MD; Carol M. Mangione, MD, MSPH; Lori Pbert, PhD; Michael Silverstein, MD, MPH; Melissa A. Simon, MD, MPH; Chien-Wen Tseng, MD, MPH, MSEE; John B. Wong, MD.

Affiliations of The US Preventive Services Task Force (USPSTF) members: Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Owens); Stanford University, Stanford, California (Owens); Feinstein Institute for Medical Research at Northwell Health, Manhasset, New York (Davidson); Fairfax Family Practice Residency, Fairfax, Virginia (Krist); Virginia Commonwealth University, Richmond (Krist); Harvard Medical School, Boston, Massachusetts (Barry); University of California, San Francisco (Cabana); Oregon Health & Science University, Portland (Caughey); University of Iowa, Iowa City (Curry); Mayo Clinic, Rochester, Minnesota (Doubeni); Virginia Tech Carilion School of Medicine, Roanoke (Epling Jr); Temple University, Philadelphia, Pennsylvania (Kubik); University of Alabama at Birmingham (Landefeld); University of California, Los Angeles (Mangione); University of Massachusetts Medical School, Worcester (Pbert); Boston University, Boston, Massachusetts (Silverstein); Northwestern University, Evanston, Illinois (Simon); University of Hawaii, Honolulu (Tseng); Pacific Health Research and Education Institute, Honolulu, Hawaii (Tseng); Tufts University School of Medicine, Boston, Massachusetts (Wong).

Author Contributions: Dr Owens had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The USPSTF members contributed equally to the recommendation statement.

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Authors followed the policy regarding conflicts of interest described at https://www.uspreventiveservicestaskforce.org/Page/Name/conflict-of-interest-disclosures. All members of the USPSTF receive travel reimbursement and an honorarium for participating in USPSTF meetings.

Funding/Support: The USPSTF is an independent, voluntary body. The US Congress mandates that the Agency for Healthcare Research and Quality (AHRQ) support the operations of the USPSTF.

Role of the Funder/Sponsor: AHRQ staff assisted in the following: development and review of the research plan, commission of the systematic evidence review from an Evidence-based Practice Center, coordination of expert review and public comment of the draft evidence report and draft recommendation statement, and the writing and preparation of the final recommendation statement and its submission for publication. AHRQ staff had no role in the approval of the final recommendation statement or the decision to submit for publication.

Disclaimer: Recommendations made by the USPSTF are independent of the US government. They should not be construed as an official position of AHRQ or the US Department of Health and Human Services.

Additional Contributions: We thank Howard Tracer, MD (AHRQ), who contributed to the writing of the manuscript, and Lisa Nicolella, MA (AHRQ), who assisted with coordination and editing.

References
1.
National Cancer Institute (NCI). Cancer Stat Facts: pancreatic cancer. NCI website. https://seer.cancer.gov/statfacts/html/pancreas.html. Accessed June 12, 2019.
2.
Rahib  L, Smith  BD, Aizenberg  R, Rosenzweig  AB, Fleshman  JM, Matrisian  LM.  Projecting cancer incidence and deaths to 2030: the unexpected burden of thyroid, liver, and pancreas cancers in the United States.  Cancer Res. 2014;74(11):2913-2921. doi:10.1158/0008-5472.CAN-14-0155PubMedGoogle ScholarCrossref
3.
Hruban  RH, Canto  MI, Goggins  M, Schulick  R, Klein  AP.  Update on familial pancreatic cancer.  Adv Surg. 2010;44:293-311. doi:10.1016/j.yasu.2010.05.011PubMedGoogle ScholarCrossref
4.
Kamisawa  T, Wood  LD, Itoi  T, Takaori  K.  Pancreatic cancer.  Lancet. 2016;388(10039):73-85. doi:10.1016/S0140-6736(16)00141-0PubMedGoogle ScholarCrossref
5.
Klein  AP.  Genetic susceptibility to pancreatic cancer.  Mol Carcinog. 2012;51(1):14-24. doi:10.1002/mc.20855PubMedGoogle ScholarCrossref
6.
Chari  ST, Kelly  K, Hollingsworth  MA,  et al.  Early detection of sporadic pancreatic cancer: summative review.  Pancreas. 2015;44(5):693-712. doi:10.1097/MPA.0000000000000368PubMedGoogle ScholarCrossref
7.
Chang  JC, Kundranda  M.  Novel diagnostic and predictive biomarkers in pancreatic adenocarcinoma.  Int J Mol Sci. 2017;18(3):E667. doi:10.3390/ijms18030667PubMedGoogle ScholarCrossref
8.
Loosen  SH, Neumann  UP, Trautwein  C, Roderburg  C, Luedde  T.  Current and future biomarkers for pancreatic adenocarcinoma.  Tumour Biol. 2017;39(6):1010428317692231. doi:10.1177/1010428317692231PubMedGoogle ScholarCrossref
9.
Choe  JW, Kim  JS, Kim  HJ,  et al.  Value of early check-up of carbohydrate antigen 19-9 levels for pancreatic cancer screening in asymptomatic new-onset diabetic patients.  Pancreas. 2016;45(5):730-734. doi:10.1097/MPA.0000000000000538PubMedGoogle ScholarCrossref
10.
Dumstrei  K, Chen  H, Brenner  H.  A systematic review of serum autoantibodies as biomarkers for pancreatic cancer detection.  Oncotarget. 2016;7(10):11151-11164. doi:10.18632/oncotarget.7098PubMedGoogle ScholarCrossref
11.
Herreros-Villanueva  M, Bujanda  L.  Non-invasive biomarkers in pancreatic cancer diagnosis: what we need versus what we have.  Ann Transl Med. 2016;4(7):134. doi:10.21037/atm.2016.03.44PubMedGoogle ScholarCrossref
12.
Henrikson  NB, Aiello Bowles  EJ, Blasi  PR,  et al.  Screening for Pancreatic Cancer: A Systematic Evidence Review for the US Preventive Services Task Force: Evidence Synthesis No. 181. Rockville, MD: Agency for Healthcare Research and Quality; 2019. AHRQ publication 19-05250-EF-1.
13.
Henrikson  NB, Aiello Bowles  EJ, Blasi  PR,  et al.  Screening for pancreatic cancer: updated evidence report and systematic review for the US Preventive Services Task Force  [published August 6, 2019].  JAMA. doi:10.1001/jama.2019.6190Google Scholar
14.
Joergensen  MT, Gerdes  AM, Sorensen  J, Schaffalitzky de Muckadell  O, Mortensen  MB.  Is screening for pancreatic cancer in high-risk groups cost-effective? experience from a Danish national screening program.  Pancreatology. 2016;16(4):584-592. doi:10.1016/j.pan.2016.03.013PubMedGoogle ScholarCrossref
15.
Harinck  F, Konings  IC, Kluijt  I,  et al; Dutch Research Group on Pancreatic Cancer Surveillance in High-Risk Individuals.  A multicentre comparative prospective blinded analysis of EUS and MRI for screening of pancreatic cancer in high-risk individuals.  Gut. 2016;65(9):1505-1513. doi:10.1136/gutjnl-2014-308008PubMedGoogle ScholarCrossref
16.
Al-Sukhni  W, Borgida  A, Rothenmund  H,  et al.  Screening for pancreatic cancer in a high-risk cohort: an eight-year experience.  J Gastrointest Surg. 2012;16(4):771-783. doi:10.1007/s11605-011-1781-6PubMedGoogle ScholarCrossref
17.
Schneider  R, Slater  EP, Sina  M,  et al.  German national case collection for familial pancreatic cancer (FaPaCa): ten years experience.  Fam Cancer. 2011;10(2):323-330. doi:10.1007/s10689-010-9414-xPubMedGoogle ScholarCrossref
18.
Verna  EC, Hwang  C, Stevens  PD,  et al.  Pancreatic cancer screening in a prospective cohort of high-risk patients: a comprehensive strategy of imaging and genetics.  Clin Cancer Res. 2010;16(20):5028-5037. doi:10.1158/1078-0432.CCR-09-3209PubMedGoogle ScholarCrossref
19.
Ludwig  E, Olson  SH, Bayuga  S,  et al.  Feasibility and yield of screening in relatives from familial pancreatic cancer families.  Am J Gastroenterol. 2011;106(5):946-954. doi:10.1038/ajg.2011.65PubMedGoogle ScholarCrossref
20.
Poley  JW, Kluijt  I, Gouma  DJ,  et al.  The yield of first-time endoscopic ultrasonography in screening individuals at a high risk of developing pancreatic cancer.  Am J Gastroenterol. 2009;104(9):2175-2181. doi:10.1038/ajg.2009.276PubMedGoogle ScholarCrossref
21.
Canto  MI, Goggins  M, Yeo  CJ,  et al.  Screening for pancreatic neoplasia in high-risk individuals: an EUS-based approach.  Clin Gastroenterol Hepatol. 2004;2(7):606-621. doi:10.1016/S1542-3565(04)00244-7PubMedGoogle ScholarCrossref
22.
Canto  MI, Goggins  M, Hruban  RH,  et al.  Screening for early pancreatic neoplasia in high-risk individuals: a prospective controlled study.  Clin Gastroenterol Hepatol. 2006;4(6):766-781. doi:10.1016/j.cgh.2006.02.005PubMedGoogle ScholarCrossref
23.
Shin  EJ, Topazian  M, Goggins  MG,  et al.  Linear-array EUS improves detection of pancreatic lesions in high-risk individuals: a randomized tandem study.  Gastrointest Endosc. 2015;82(5):812-818. doi:10.1016/j.gie.2015.02.028PubMedGoogle ScholarCrossref
24.
Del Chiaro  M, Verbeke  CS, Kartalis  N,  et al.  Short-term results of a magnetic resonance imaging-based Swedish screening program for individuals at risk for pancreatic cancer.  JAMA Surg. 2015;150(6):512-518. doi:10.1001/jamasurg.2014.3852PubMedGoogle ScholarCrossref
25.
Barnes  CA, Krzywda  E, Lahiff  S,  et al.  Development of a high risk pancreatic screening clinic using 3.0 T MRI.  Fam Cancer. 2018;17(1):101-111. doi:10.1007/s10689-017-0057-zPubMedGoogle ScholarCrossref
26.
Gangi  A, Malafa  M, Klapman  J.  Endoscopic ultrasound-based pancreatic cancer screening of high-risk individuals: a prospective observational trial.  Pancreas. 2018;47(5):586-591.PubMedGoogle ScholarCrossref
27.
Andea  A, Sarkar  F, Adsay  VN.  Clinicopathological correlates of pancreatic intraepithelial neoplasia: a comparative analysis of 82 cases with and 152 cases without pancreatic ductal adenocarcinoma.  Mod Pathol. 2003;16(10):996-1006. doi:10.1097/01.MP.0000087422.24733.62PubMedGoogle ScholarCrossref
28.
Konstantinidis  IT, Vinuela  EF, Tang  LH,  et al.  Incidentally discovered pancreatic intraepithelial neoplasia: what is its clinical significance?  Ann Surg Oncol. 2013;20(11):3643-3647. doi:10.1245/s10434-013-3042-2PubMedGoogle ScholarCrossref
29.
Sharib  JM, Fonseca  AL, Swords  DS,  et al.  Surgical overtreatment of pancreatic intraductal papillary mucinous neoplasms: do the 2017 International Consensus Guidelines improve clinical decision making?  Surgery. 2018;164(6):1178-1184. doi:10.1016/j.surg.2018.07.014PubMedGoogle ScholarCrossref
30.
Tanaka  M, Fernández-Del Castillo  C, Kamisawa  T,  et al.  Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas.  Pancreatology. 2017;17(5):738-753. doi:10.1016/j.pan.2017.07.007PubMedGoogle ScholarCrossref
31.
Maheu  C, Vodermaier  A, Rothenmund  H,  et al.  Pancreatic cancer risk counselling and screening: impact on perceived risk and psychological functioning.  Fam Cancer. 2010;9(4):617-624. doi:10.1007/s10689-010-9354-5PubMedGoogle ScholarCrossref
32.
Konings  IC, Sidharta  GN, Harinck  F,  et al.  Repeated participation in pancreatic cancer surveillance by high-risk individuals imposes low psychological burden.  Psychooncology. 2016;25(8):971-978. doi:10.1002/pon.4047PubMedGoogle ScholarCrossref
33.
Canto  MI, Hruban  RH, Fishman  EK,  et al; American Cancer of the Pancreas Screening (CAPS) Consortium.  Frequent detection of pancreatic lesions in asymptomatic high-risk individuals.  Gastroenterology. 2012;142(4):796-804. doi:10.1053/j.gastro.2012.01.005PubMedGoogle ScholarCrossref
34.
Kamphues  C, Bova  R, Schricke  D,  et al.  Postoperative complications deteriorate long-term outcome in pancreatic cancer patients.  Ann Surg Oncol. 2012;19(3):856-863. doi:10.1245/s10434-011-2041-4PubMedGoogle ScholarCrossref
35.
McPhee  JT, Hill  JS, Whalen  GF,  et al.  Perioperative mortality for pancreatectomy: a national perspective.  Ann Surg. 2007;246(2):246-253. doi:10.1097/01.sla.0000259993.17350.3aPubMedGoogle ScholarCrossref
36.
Swanson  RS, Pezzi  CM, Mallin  K, Loomis  AM, Winchester  DP.  The 90-day mortality after pancreatectomy for cancer is double the 30-day mortality: more than 20,000 resections from the National Cancer Data Base.  Ann Surg Oncol. 2014;21(13):4059-4067. doi:10.1245/s10434-014-4036-4PubMedGoogle ScholarCrossref
37.
US Preventive Services Task Force.  Screening for Pancreatic Cancer: US Preventive Services Task Force Recommendation Statement. Rockville, MD: Agency for Healthcare Research and Quality; 2004.
38.
Syngal  S, Brand  RE, Church  JM, Giardiello  FM, Hampel  HL, Burt  RW; American College of Gastroenterology.  ACG clinical guideline: genetic testing and management of hereditary gastrointestinal cancer syndromes.  Am J Gastroenterol. 2015;110(2):223-262. doi:10.1038/ajg.2014.435PubMedGoogle ScholarCrossref
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