Original ArticleScreening for pancreatic neoplasia in high-risk individuals: an EUS-based approach☆
Section snippets
Study design and patients
In 1998, we established a screening program at Johns Hopkins Hospital for high-risk individuals. Three sources of high-risk individuals provided patients for screening (see flow diagram in Figure 1). The first source was the NFPTR. This registry, based at Johns Hopkins Hospital, was established in 1994 and it tracks patients and families with sporadic and familial pancreatic cancer.17 Families with 2 first-degree relatives affected by pancreatic cancer were defined as having familial
Patients
We received responses from 61 (74%) of the 82 high-risk individuals from NFPTR kindreds with 3 or more affected members who were invited for screening; 54 (88%) of those who responded were interested in participating in the study. The first 30 of these 54 respondents eventually were enrolled. Seven respondents were not interested in screening; one man said that he was “74 years old with adopted children” and the other 6 did not provide a specific reason for not joining the study.
The demographic
Potential clinical use of screening
This study provides important information on the feasibility and the possible importance of screening and early detection in asymptomatic high-risk individuals with a strong family history of pancreatic adenocarcinoma. From our experience to date, most individuals from our high-risk familial pancreatic cancer kindreds were interested in and willing to undergo screening, even traveling long distances at their own expense. We diagnosed and treated 6 pancreatic neoplastic masses in 7 study
Conclusions
In summary, high-risk individuals are highly interested in being screened. Our small study of highly selected subjects suggests that EUS-based screening of asymptomatic high-risk individuals can detect pancreatic neoplasia, but larger multicenter studies are needed before clinical screening recommendations can be made. Distinguishing neoplastic from nonneoplastic pancreatic lesions using imaging tests remains a challenge. The impact of pancreatic cancer screening studies may improve with the
Acknowledgements
The authors thank Lori Wroblewski, R.N., for her assistance with communicating with patients and coordinating this study.
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Supported in part by the National Cancer Institute Specialized Program in Research Excellence (SPORE) grant number 2 P50 CA62924.