SAN DIEGO — Screening for pancreatic cancer in people with a family history of the disease is not a perfect science, Dr. Marcia Irene Canto said at a meeting jointly sponsored by the AGA Institute and the Japanese Society of Gastroenterology.
“Much of our understanding of the genetics on the development of sporadic colorectal cancer stem from our understanding of familial colorectal cancer,” said Dr. Canto, director of clinical research in the division of gastroenterology and hepatology at Johns Hopkins University, Baltimore.
“Maybe we're 10 years behind in fully understanding the genetics of pancreatic cancer, but hopefully we'll get there.” Since pancreatic cancer in relatives tends to develop in the 60s, Dr. Canto recommends that family members be screened starting at age 40 years, or 10 years younger than the youngest relative with the disease.
“Clearly, known family history is a risk factor,” she said. “Screening can detect asymptomatic treatable neoplasms, as well as pancreatic neoplasms and extrapancreatic neoplasms.”
In patients with Peutz-Jeghers syndrome, pancreatic cancer tends to present in the fourth decade of life. “Therefore, we propose that perhaps you would [screen these patients] at an earlier age, maybe at age 30,” Dr. Canto said. “We don't know for sure.”
In addition, smoking increases the risk and lowers age of onset by 10 years in people with a family history of the disease. “The first thing you can do for your patients besides taking a family history is tell them to stop smoking,” she said.
Intraductal papillary mucinous neoplasm, multifocal pancreatic intraepithelial neoplasia, and lobulocentric chronic pancreatitis are part of the phenotype of familial pancreatic cancer.
The best screening tests remain unknown, but various studies in the medical literature have suggested a role for endoscopic ultrasound (EUS), computed tomography (CT), magnetic resonance imaging (MRI), combined EUS/fine needle aspiration, and endoscopic retrograde cholangiopancreatography.
In an effort to determine the optimal screening methods, Dr. Canto and her associates are currently recruiting patients for the Lustgarten Foundation for Pancreatic Cancer Research-National Cancer Institute Specialized Programs of Research Excellence Cancer of the Pancreas Screening Study (CAPS 3).
The researchers plan to screen high-risk individuals for early pancreatic neoplasia using EUS, CT, and MRI/magnetic resonance cholangiopancreatography (MRCP), and test a panel of candidate biomarkers.
They hypothesize that the use of such screening tests will make it possible to detect early curable noninvasive pancreatic neoplasia in high-risk individuals before it progresses to invasive cancer.
Patients eligible for enrollment in the study include:
▸ Adults with at least two first-degree relatives (parent, sibling, child) with pancreatic cancer. If the family has three or more relatives with the disease, then the individual must have at least one first-degree relative affected; if the family has two relatives with pancreatic cancer, then the individual must have two first-degree relatives affected.
▸ Adults with Peutz-Jeghers syndrome.
▸ Adults who are carriers of the BRCA2 or familial atypical multiple mole melanoma (FAMMM) p16(CDKN2A) gene and have at least one family member who had pancreatic cancer.
“We'll try to improve patient and physician access to screening, and it will potentially be a base for our ongoing translational studies [as well as] future and prevention and intervention trials,” Dr. Canto said of the trial.
For questions about patient enrollment, contact caps3@jhmi.edu
Each year in the United States, 31,860 people are diagnosed with pancreatic cancer and 31,270 die from the disease.