Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jul 25, 2015; 7(9): 833-842
Published online Jul 25, 2015. doi: 10.4253/wjge.v7.i9.833
Methods and outcomes of screening for pancreatic adenocarcinoma in high-risk individuals
Gabriele Capurso, Marianna Signoretti, Roberto Valente, Urban Arnelo, Matthias Lohr, Jan-Werner Poley, Gianfranco Delle Fave, Marco Del Chiaro
Gabriele Capurso, Marianna Signoretti, Roberto Valente, Gianfranco Delle Fave, Digestive and Liver Disease Unit, S. Andrea Hospital, University Sapienza, 00199 Rome, Italy
Marianna Signoretti, Jan-Werner Poley, Departments of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, 3015 CE Rotterdam, The Netherlands
Roberto Valente, Urban Arnelo, Matthias Lohr, Marco Del Chiaro, Pancreatic Surgery Unit, Division of Surgery, CLINTEC, Karolinska Institutet at Karolinska University Hospital, SE-171 76 Stockholm, Sweden
Author contributions: Capurso G and Del Chiaro M designed the study; Capurso G, Signoretti M, Valente R, Arnelo U, Lohr M, Poley JW, Delle Fave G and Del Chiaro M gave substantial contribution to acquisition and analysis of data and drafting of the article; Capurso G, Signoretti M, Valente R, Arnelo U, Lohr M, Poley JW, Delle Fave G and Del Chiaro M revised it critically and approved the version to be published.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Gabriele Capurso, MD, PhD, Digestive and Liver Disease Unit, S. Andrea Hospital, University Sapienza, Via di Grottarossa 1035, 00199 Rome, Italy. gabriele.capurso@gmail.com
Telephone: +39-6-33775691 Fax: +39-6-33775526
Received: February 23, 2015
Peer-review started: February 26, 2015
First decision: April 27, 2015
Revised: May 13, 2015
Accepted: June 9, 2015
Article in press: June 11, 2015
Published online: July 25, 2015
Processing time: 161 Days and 14.6 Hours
Abstract

Pancreatic ductal adenocarcinoma (PDAC) is a lethal neoplasia, for which secondary prevention (i.e., screening) is advisable for high-risk individuals with “familiar pancreatic cancer” and with other specific genetic syndromes (Peutz-Jeghers, p16, BRCA2, PALB and mismatch repair gene mutation carriers). There is limited evidence regarding the accuracy of screening tests, their acceptability, costs and availability, and agreement on whom to treat. Successful target of screening are small resectable PDAC, intraductal papillary mucinous neoplasms with high-grade dysplasia and advanced pancreatic intraepithelial neoplasia. Both magnetic resonance imaging (MRI) and endoscopic ultrasound (EUS) are employed for screening, and the overall yield for pre-malignant or malignant pancreatic lesions is of about 20% with EUS and 14% with MRI/magnetic resonance colangiopancreatography. EUS performs better for solid and MRI for cystic lesions. However, only 2% of these detected lesions can be considered a successful target, and there are insufficient data demonstrating that resection of benign or low grade lesions improves survival. Many patients in the published studies therefore seemed to have received an overtreatment by undergoing surgery. It is crucial to better stratify the risk of malignancy individually, and to better define optimal screening intervals and methods either with computerized tools or molecular biomarkers, possibly in large multicentre studies. At the moment, screening should be carefully performed within research protocols at experienced centres, offering involved individuals medical and psychological advice.

Keywords: Endoscopic ultrasound; Pancreatic cancer; Screening; High-risk individuals; Magnetic resonance

Core tip: Screening for pancreatic cancer is advisable for high-risk individuals. There is limited evidence regarding the accuracy of screening tests, their acceptability, costs and availability, and agreement on whom to treat. Successful target of screening are small resectable pancreatic ductal adenocarcinoma, intraductal papillary mucinous neoplasms with high-grade dysplasia and advanced pancreatic intraepithelial neoplasia. Both magnetic resonance imaging (MRI) and endoscopic ultrasound (EUS) are employed for screening, and the overall yield for pre-malignant or malignant pancreatic lesions is of about 20% with EUS and 14% with MRI/magnetic resonance colangiopancreatography. However, only 2% of these detected lesions can be considered a successful target. It is crucial to better stratify the risk of malignancy individually, and to better define optimal screening intervals and methods.