Outcomes of endoscopic ultrasound as a one-off pancreatic cancer screening tool for 122 high- and moderate-risk patients.

Marios Efthymiou,Allison Collins,Anton Rajadurai,Mehrdad Nikfarjam,Rhys Vaughan,Leonardo Zorron Cheng Tao Pu,Sujievvan Chandran

doi:10.1002/jgh3.12432

Abstract

Background and AimPancreatic cancer (PC) carries a poor prognosis and is often detected at later stages. Screening programs for moderate‐ and high‐risk people are still under debate. We present the results from a prospective study on endoscopic ultrasound (EUS) as a one‐off screening tool for pancreatic cancer screening.MethodsAsymptomatic patients with moderate‐ or high‐risk of PC were invited to participate. Moderate risk consisted of one first‐degree and at least one second‐degree relative with PC and no PC‐associated genetic mutations. High risk consisted of >1 first‐degree relatives with PC or PC‐associated mutations (i.e. BRCA2, Lynch Syndrome, Familial Atypical Multiple Mole Melanoma Syndrome, STK11, or PALB2). All included patients had genetic counseling and a screening EUS done. Primary outcome was the detection of PC on EUS. Secondary outcomes assessed the evolution of psychological symptoms based on the Impact of Events Scale (IES) and Personal Consequences Questionnaire (PCQ) before and after the screening took place.ResultsA total of 122 patients had a screening EUS performed between 2013 and 2019; 60 were male, 55.8 years was the mean age, 78 were at high risk for PC, and 25 had PC‐associated mutations. No pancreatic cancers were identified at the one‐off EUS screening. Overall, patients' IES/PCQ scores did not change after screening and feedback of no malignancy, with the exception of females (less concerned about PC after screening EUS).ConclusionsEUS did not detect any PCs in either a moderate‐ or high‐risk population as a one‐off screening method. The EUS procedure and genetic counseling improved psychological symptoms for the female subset of this population.

Highlights

In 2019, Australia registered over 3500 new pancreatic cancer (PC) cases (11.6 per 100 000) and more than 3000 PC deaths (11.6 per 100 000).[1]
The high-risk group consisted of slightly older people, had a higher percentage of the male gender, and had a lower percentage of active smokers (Table 1)
PC screening has been proposed by several groups, and more recently in a consensus, as potentially beneficial but is still only carried out in academic tertiary centers.[17]

Summary

Introduction

In 2019, Australia registered over 3500 new pancreatic cancer (PC) cases (11.6 per 100 000) and more than 3000 PC deaths (11.6 per 100 000).[1]. Early diagnosis leads to improved prognosis and forms the basis of screening programs. Both family history of PC and PC-associated genetic mutations have been shown to contribute to elevating the risk for PC.[4] Approximately 5–10% of PCs are due to genetic. Moderate risk consisted of one first-degree and at least one second-degree relative with PC and no PC-associated genetic mutations. Results: A total of 122 patients had a screening EUS performed between 2013 and 2019; 60 were male, 55.8 years was the mean age, 78 were at high risk for PC, and 25 had PC-associated mutations. Conclusions: EUS did not detect any PCs in either a moderate- or high-risk population as a one-off screening method. The EUS procedure and genetic counseling improved psychological symptoms for the female subset of this population

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