Management of patients with increased risk for familial pancreatic cancer: updated recommendations from the International Cancer of the Pancreas Screening (CAPS) Consortium. Issue 1 (31st October 2019)

• Record Type: Journal Article
• Authors: Goggins, Michael; Overbeek, Kasper Alexander; Brand, Randall; Syngal, Sapna; Del Chiaro, Marco; Bartsch, Detlef K; Bassi, Claudio; Carrato, Alfredo; Farrell, James; Fishman, Elliot K; Fockens, Paul; Gress, Thomas M; van Hooft, Jeanin E; Hruban, R H; Kastrinos, Fay; Klein, Allison; Lennon, Anne Marie; Lucas, Aimee; Park, Walter; Rustgi, Anil; Simeone, Diane; Stoffel, Elena; Vasen, Hans F A; Cahen, Djuna L; Canto, Marcia Irene; Bruno, Marco
• Other Names: author non-byline.; Arcidiacono Paolo Giorgio author non-byline.; Ashida Reiko author non-byline.; Ausems Margreet author non-byline.; Besselink Marc author non-byline.; Biermann Katharina author non-byline.; Bonsing Bert author non-byline.; Brentnall Teri author non-byline.; Chak Amitabh author non-byline.; Early Dayna author non-byline.; Castillo Carloz Fernandez-Del author non-byline.; Frucht Harold author non-byline.; Furukawa Toru author non-byline.; Gallinger Steven author non-byline.; Geurts Jennifer author non-byline.; Koerkamp Bas Groot author non-byline.; Hammel Pascal author non-byline.; Hes Frederik author non-byline.; Iglesias-Garcia Julio author non-byline.; Kamel Ihab author non-byline.; Kitano Masayuki author non-byline.; Klöppel Günter author non-byline.; Krak Nanda author non-byline.; Kurtz Robert author non-byline.; Kwon Richard author non-byline.; Lachter Jesse author non-byline.; Lee Jeffrey author non-byline.; Levy Michael author non-byline.; Malleo Giuseppe author non-byline.; Meguid Cheryl author non-byline.; Maitra Anirban author non-byline.; Margolis Daniel author non-byline.; Offerhaus Johan author non-byline.; Olson Sara author non-byline.; Paiella Salvatore author non-byline.; Park Walter author non-byline.; Petersen Gloria author non-byline.; Poley Jan-Werner author non-byline.; Real Francisco X author non-byline.; Saltzman John author non-byline.; Schulick Richard author non-byline.; Stoita Alina author non-byline.; Takaori Kyoichi author non-byline.; Tanaka Masao author non-byline.; Tamm Eric author non-byline.; Topazian Mark author non-byline.; Vazquez-Sequeiros Enrique author non-byline.; Vleggaar Frank author non-byline.; Vos tot Nederveen Cappel Wouter De author non-byline.; Yeo Charles author non-byline.; Wasser Martin author non-byline.; Wagner Anja author non-byline.; Wallace Michael author non-byline.; Wolfgang Christopher author non-byline.; Wood Laura author non-byline.;
• Is Part Of: Gut. Volume 69:Issue 1(2020)
• Page Start: 7
• Page End: 17
• Publication Date: 2019-10-31
• Subjects: early detection -- familial pancreatic cancer -- genetic predisposition -- pancreatic ductal adenocarcinoma -- surveillance; Gastroenterology -- Periodicals; 616.33
• DOI: 10.1136/gutjnl-2019-319352
• Languages: English
• ISSNs: 0017-5749

Abstract

Abstract : Background and aim: The International Cancer of the Pancreas Screening Consortium met in 2018 to update its consensus recommendations for the management of individuals with increased risk of pancreatic cancer based on family history or germline mutation status (high-risk individuals). Methods: A modified Delphi approach was employed to reach consensus among a multidisciplinary group of experts who voted on consensus statements. Consensus was considered reached if ≥75% agreed or disagreed. Results: Consensus was reached on 55 statements. The main goals of surveillance (to identify high-grade dysplastic precursor lesions and T1N0M0 pancreatic cancer) remained unchanged. Experts agreed that for those with familial risk, surveillance should start no earlier than age 50 or 10 years earlier than the youngest relative with pancreatic cancer, but were split on whether to start at age 50 or 55. Germline ATM mutation carriers with one affected first-degree relative are now considered eligible for surveillance. Experts agreed that preferred surveillance tests are endoscopic ultrasound and MRI/magnetic retrograde cholangiopancreatography, but no consensus was reached on how to alternate these modalities. Annual surveillance is recommended in the absence of concerning lesions. Main areas of disagreement included if and how surveillance should be performed for hereditary pancreatitis, and the management of indeterminate lesions. Conclusions: Pancreatic surveillance is recommended for selected high-risk individuals to detect early pancreatic cancer and its high-grade precursors, but should be performed in a research setting by multidisciplinary teams in centres with appropriate expertise. Until more evidence supporting these recommendations is available, the benefits, risks and costs of surveillance of pancreatic surveillance need additional evaluation.