Screening for pancreatic cancer-a compelling challenge.

Abstract

The publication of the American Gastroenterology Association (AGA) Clinical Practice Update on Pancreas Cancer Screening in High-Risk Individuals (HRIs) underlines the increasing attention for this topic (1). Secondary prevention (surveillance) for pancreatic ductal adenocarcinoma (PDAC), however, remains a challenge with many unsolved questions (Table 1). Revisiting the ten Wilson-Jungner criteria (2) for appraising a screening program’s validity, when it comes to PDAC most have not been satisfied. Particularly, the fundamental principle that “treatment at an early stage should be of more benefit than at a later stage” has been scarcely investigated. The Johns Hopkins single-center experience reported promising efficacy results in terms of survival, with a median survival of 5.3 years [interquartile range (IQR), 1.2–11.1 years] and an outstanding 85% 3-year survival rate (3). Notably, several studies and some meta-analyses have shown that the diagnostic yield of pre-malignant or malignant lesions in HRIs undergoing screening/surveillance is much higher than the 1.6% lifetime risk of PDAC in unselected individuals. The lifetime risk of PDAC is as high as 40–60% in PeutzJeghers syndrome (PJS) or hereditary pancreatitis (HP) patients, or in the presence of ≥3 first-degree relatives (4-6). However, these reports’ results do not provide evidence of survival benefits over time, leaving the issue of whether a screening/surveillance program for PDAC is effective still unsolved. Who should be screened?