TY - JOUR
T1 - Management of patients with increased risk for familial pancreatic cancer: Updated recommendations from the International Cancer of the Pancreas Screening (CAPS) Consortium
AU - Goggins, Michael
AU - Overbeek, Kasper Alexander
AU - Brand, Randall
AU - Syngal, Sapna
AU - del Chiaro, Marco
AU - Bartsch, Detlef K.
AU - Bassi, Claudio
AU - Carrato, Alfredo
AU - Farrell, James
AU - Fishman, Elliot
AU - Fockens, Paul
AU - Gress, Thomas M.
AU - van Hooft, Jeanin E.
AU - Hruban, R. H.
AU - Kastrinos, Fay
AU - Klein, Allison
AU - Lennon, Anne Marie
AU - Lucas, Aimee
AU - Park, Walter
AU - Rustgi, Anil
AU - Simeone, Diane
AU - Stoffel, Elena
AU - Vasen, Hans F. A.
AU - Cahen, Djuna L.
AU - Canto, Marcia Irene
AU - Bruno, Marco
PY - 2019
Y1 - 2019
N2 - 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.
AB - 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.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85074476875&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/31672839
U2 - https://doi.org/10.1136/gutjnl-2019-319352
DO - https://doi.org/10.1136/gutjnl-2019-319352
M3 - Article
C2 - 31672839
SN - 0017-5749
JO - Gut
JF - Gut
M1 - 319352
ER -