Thursday, January 5, 2012

Screening for Pancreatic Cancer - Recommendation Statement


The U.S. Preventive Services Task Force (USPSTF) recommends against routine screening for pancreatic cancer in asymptomatic adults using abdominal palpation, ultrasonography, or serologic markers.

The USPSTF found no evidence that screening for pancreatic cancer is effective in reducing mortality. There is a potential for significant harm because of the very low prevalence of pancreatic cancer, limited accuracy of available screening tests, the invasive nature of diagnostic tests, and the poor outcomes of treatment. As a result, the USPSTF concluded that the harms of screening for pancreatic cancer exceed any potential benefits.

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This statement summarizes the U.S. Preventive Services Task Force (USPSTF) recommendations on screening for pancreatic cancer and the supporting scientific evidence, and updates the 1996 recommendations contained in the Guide to Clinical Preventive Services, second edition. In 1996, the USPSTF recommended against screening for pancreatic cancer. Since then, the USPSTF criteria to rate the strength of the evidence have changed.  Therefore, this recommendation statement has been updated and revised based on the current USPSTF methodology and rating of the strength of the evidence.

The Task Force grades its recommendations according to one of 5 classifications (A, B, C, D, I) reflecting the strength of evidence and magnitude of net benefit (benefits minus harms):
  1. The USPSTF strongly recommends that clinicians provide [the service] to eligible patients. The USPSTF found good evidence that [the service] improves important health outcomes and concludes that benefits substantially outweigh harms.
  2. The USPSTF recommends that clinicians provide [the service] to eligible patients. The USPSTF found at least fair evidence that [the service] improves important health outcomes and concludes that benefits outweigh harms.
  3. The USPSTF makes no recommendation for or against routine provision of [the service]. The USPSTF found at least fair evidence that [the service] can improve health outcomes but concludes that the balance of benefits and harms is too close to justify a general recommendation.
  4. The USPSTF recommends against routinely providing [the service] to asymptomatic patients. The USPSTF found at least fair evidence that [the service] is ineffective or that harms outweigh benefits.
  5. The USPSTF concludes that the evidence is insufficient to recommend for or against routinely providing [the service]. Evidence that [the service] is effective is lacking, of poor quality, or conflicting and the balance of benefits and harms cannot be determined.

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So, thanks to the professionals who changed their minds and moderately recommend the screening for pancreatic cancer for the high-risk population to be performed. An ideal pancreatic cancer screening test should be a safe, inexpensive, highly accurate test that reliably diagnoses pancreas cancer at a stage when it is not causing symptoms in the patient. This would provide that person the opportunity to take appropriate and effective action to treat and potentially cure the disease.

Unfortunately, screening tests for pancreas cancer meeting these demands do not exist. However, changes in official medical science reflect the fact that the potential for screening this disease is considerably improved compared to just a few years ago.

Note that pancreatic cancer screening still is not recommended for the general population, but there are people who are in high-risk categories that should consider to be screened. Screening definitely makes sense for people who are at risk for the disease, typically because of hereditary factors or genetic syndromes that increase substantially the likelihood of developing pancreatic cancer.

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Factors that Increase an Individual's Risk for Pancreatic Cancer:

  • Two or more first-degree relatives (parents, sibling, child) with pancreatic cancer.
  • One first-degree relative diagnosed with pancreatic cancer at an early age (under the age of 50).
  • Two or more second-degree relatives (grandparent, aunt/uncle, niece/nephew, half-sibling) with pancreatic cancer, one of whom developed it at an early age.
  • History of a cancer syndrome associated with pancreatic cancer:
    • Hereditary pancreatitis
Genetic Mutation: PRSSI
Clinical Clues: History of early pancreatitis (inflammation of the pancreas) of unknown cause.

    • Breast-ovarian cancer syndrome
Genetic Mutation: BRCA2
Clinical Clues: History of breast and/or ovarian cancer.

    • Hereditary nonpolyposis colorectal cancer syndrome
Genetic Mutation: Mismatch repair genes
Clinical Clues: Personal or family history of early colorectal cancer.

    • Familial atypical multiple mole melanoma syndrome (FAMMM)
Genetic Mutation: CDK2NA/p16
Clinical Clues: Multiple melanomas with or without history of pancreatic malignancy.

    • Peutz-Jeghers syndrome
Genetic Mutation: STK11/LKB1
Clinical Clues: Benign polyps of the gastrointestinal tract with pigmented macules on the lips, inner lining of the cheeks, and hands/feet



Sources and Additional Information:


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