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Screening for Pancreatic Cancer: Why, How, and Who?
Open accessAbstract
In Brief Pancreatic cancer is the fourth most common cause of cancer mortality in the United States, with 5-year survival rates for patients with resectable tumors ranging from 15% to 20%. However, most patients presenting with distant metastases, are not resectable, and have a 5-year survival rate of close to 0%. This demonstrates a need for improved screening to identify pancreatic cancer while the tumor is still localized and amenable to surgical resection. Studies of patients with pancreatic tumors incidentally diagnosed demonstrate longer median survival than tumors discovered only when the patient is symptomatic, suggesting that early detection may improve outcome. Recent evidence from genomic sequencing indicates a 15-year interval for genetic progression of pancreatic cancer from initiation to the metastatic stage, suggesting a sufficient window for early detection. Still, many challenges remain in implementing effective screening. Early diagnosis of pancreatic cancer relies on developing screening methodologies with highly sensitive and specific biomarkers and imaging modalities. It also depends on a better understanding of the risk factors and natural history of the disease to accurately identify high-risk groups that would be best served by screening. This review summarizes our current understanding of the biology of pancreatic cancer relevant to methods available for screening. At this time, given the lack of proven benefit in this disease, screening efforts should probably be undertaken in the context of prospective trials. Pancreatic adenocarcinoma is a largely fatal disease with increased survival for patients with localized disease compared with those with distant metastases. A critical evaluation of early detection strategies is presented in light of results from more common cancers. Improved outcomes may be attained by focusing screening on high-risk groups; however, these efforts are as yet unproven.
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“Screening individuals in high-risk groups increases the rate of detection and reduces false-positive results.8”
From Early detection of pancreatic cancer (2020) · cites this paper as [8]
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“Similarly, incidentally diagnosed pancreatic ductal adenocarcinoma (ie, discovered serendipitously while screening or checking for other diseases) is associated with longer median survival than pancreatic ductal adenocarcinoma that is diagnosed when patients have symptoms.8”
From Early detection of pancreatic cancer (2020) · cites this paper as [8]
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“Patients diagnosed with stage 1 disease experience longer survival times than patients diagnosed with disease at more advanced stages.8”
From Early detection of pancreatic cancer (2020) · cites this paper as [8]
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1 retracted
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Raimondi, S., Lowenfels, A. B., Morselli‐Labate, A. M., Maisonneuve, P., & Pezzilli, R. (2010) · Best Practice & Research Clinical Gastroenterology · doi:10.1016/j.bpg.2010.02.007 · Cited by 653
Worldwide Burden of, Risk Factors for, and Trends in Pancreatic Cancer
Huang, J., Lok, V., Ngai, C. H., Zhang, L., Yuan, J., Lao, X. Q., Ng, K. K., Chong, C. C. N., Zheng, Z., & Wong, M. C. S. (2020) · Gastroenterology · doi:10.1053/j.gastro.2020.10.007 · Cited by 539
Addressing the challenges of pancreatic cancer: Future directions for improving outcomes
Hidalgo, M. M., Cascinu, S., Kleeff, J. H., Labianca, R., Löhr, M. J., Neoptolemos, J. P., Real, F. X., Laethem, J. V., & Heinemann, V. (2014) · Pancreatology · doi:10.1016/j.pan.2014.10.001 · Cited by 530
Orth, M., Metzger, P., Gerum, S., Mayerle, J. V., Schneider, G., Belka, C., Schnurr, M., & Lauber, K. (2019) · Radiation Oncology · doi:10.1186/s13014-019-1345-6 · Cited by 523
Early detection of pancreatic cancer
Pereira, S. P., Oldfield, L., Ney, A., Hart, P. A., Keane, M. G., Pandol, S. J., Li, D., Greenhalf, W., Jeon, C. Y., Koay, E. J., et al. (2020) · The Lancet Gastroenterology & Hepatology · doi:10.1016/s2468-1253(19)30416-9 · Cited by 482
Metadata
- Authors
- Poruk, K. E., Firpo, M. A., Adler, D. G., & Mulvihill, S. J.
- Affiliations
- University of Utah (US)
- Corresponding author
- Poruk, Katherine E.
- Venue
- Annals of Surgery
- Published
- 2013-01
- Volume
- 257
- Issue
- 1
- Pages
- 17-26
- ISSN
- 0003-4932 (ISSN-L)
- PMC
- PMC4113008
- OpenAlex
- W2050410927
- Cited by
- 249
- References
- 117
- Citations by year
- 2026: 5 · 2025: 12 · 2024: 16 · 2023: 25 · 2022: 33 · 2021: 16 · 2020: 24 · 2019: 25 · 2018: 14 · 2017: 25 · 2016: 18 · 2015: 15 · 2014: 15 · 2013: 4
- FWCI
- 1.16
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Annals of Surgery (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (T35HL007744)
- National Cancer Institute (U01CA151650, R03CA115225, U01CA15165, R33CA155586, P30CA042014)
- Topics
- Health Sciences › Medicine › Oncology › Pancreatic and Hepatic Oncology Research
- Health Sciences › Medicine › Surgery › Pancreatitis Pathology and Treatment
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Keywords
- pancreatic cancer, cancer screening, early detection, pancreatic ductal adenocarcinoma, biomarkers, imaging modalities, high-risk groups, risk factors, natural history of disease, resectability, survival
- MeSH terms
- Adenocarcinoma, Humans, Magnetic Resonance Imaging, Pancreatic Neoplasms, Precancerous Conditions, Risk Factors, Sensitivity and Specificity, Tomography, X-Ray Computed, Biomarkers, Tumor, United States, Endosonography, Early Detection of Cancer
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