International Cancer of the Pancreas Screening (CAPS) Consortium summit on the management of patients with increased risk for familial pancreatic cancer
Open accessAbstract
Background: Screening individuals at increased risk for pancreatic cancer (PC) detects early, potentially curable, pancreatic neoplasia. Objective: To develop consortium statements on screening, surveillance and management of high-risk individuals with an inherited predisposition to PC. Methods: A 49-expert multidisciplinary international consortium met to discuss pancreatic screening and vote on statements. Consensus was considered reached if ≥75% agreed or disagreed. Results: There was excellent agreement that, to be successful, a screening programme should detect and treat T1N0M0 margin-negative PC and high-grade dysplastic precursor lesions (pancreatic intraepithelial neoplasia and intraductal papillary mucinous neoplasm). It was agreed that the following were candidates for screening: first-degree relatives (FDRs) of patients with PC from a familial PC kindred with at least two affected FDRs; patients with Peutz–Jeghers syndrome; and p16 , BRCA 2 and hereditary non-polyposis colorectal cancer (HNPCC) mutation carriers with ≥1 affected FDR. Consensus was not reached for the age to initiate screening or stop surveillance. It was agreed that initial screening should include endoscopic ultrasonography (EUS) and/or MRI/magnetic resonance cholangiopancreatography not CT or endoscopic retrograde cholangiopancreatography. There was no consensus on the need for EUS fine-needle aspiration to evaluate cysts. There was disagreement on optimal screening modalities and intervals for follow-up imaging. When surgery is recommended it should be performed at a high-volume centre. There was great disagreement as to which screening abnormalities were of sufficient concern to for surgery to be recommended. Conclusions: Screening is recommended for high-risk individuals, but more evidence is needed, particularly for how to manage patients with detected lesions. Screening and subsequent management should take place at high-volume centres with multidisciplinary teams, preferably within research protocols.
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Pancreas surveillance has been recommended for individuals estimated to be at high risk of developing PDAC (5% or higher estimated lifetime risk).
“Pancreas surveillance has been recommended for individuals estimated to be at high risk of developing PDAC (5% or higher estimated lifetime risk).5-8”
From The Multicenter Cancer of Pancreas Screening Study: Impact on Stage and Survival (2022) · cites this paper as [5]
The US Preventive Services Task Force and other guidelines recommend against screening for pancreatic ductal adenocarcinoma in asymptomatic adults at average risk.
“The US Preventive Services Task Force and other guidelines recommend against screening for pancreatic ductal adenocarcinoma in asymptomatic adults at average risk.6,53,54”
From Early detection of pancreatic cancer (2020) · cites this paper as [6]
All screening programmes for pancreatic ductal adenocarcinoma aim to detect and treat T1N0M0 cancers or high-grade dysplastic premalignant lesions.
“All screening programmes for pancreatic ductal adenocarcinoma aim to detect and treat T1N0M0 cancers or high-grade dysplastic premalignant lesions (ie, pancreatic intraepithelial neoplasia 3 or mucinous cystic tumours with high-grade dysplasia).6,54”
From Early detection of pancreatic cancer (2020) · cites this paper as [6]
The 5% lifetime-risk target group includes individuals with at least two first-degree relatives with pancreatic ductal adenocarcinoma, patients with hereditary pancreatitis or particular genetic syndromes, and individuals with mucinous cystic lesions of the pancreas.
“This target includes individuals with at least two first-degree relatives with pancreatic ductal adenocarcinoma, patients with hereditary pancreatitis or particular genetic syndromes (eg, Peutz-Jeghers syndrome, or germline mutations in the CDKN2A, BRCA2, or PALB2),6,54 and individuals with mucinous cystic lesions of the pancreas.19–21”
From Early detection of pancreatic cancer (2020) · cites this paper as [6]
International guidelines and a white paper on early detection recommend targeted screening of individuals whose lifetime risk of pancreatic ductal adenocarcinoma is higher than 5%.
“However, international guidelines and a white paper on the early detection of pancreatic ductal adenocarcinoma recommend targeted screening of individuals whose lifetime risk of developing pancreatic ductal adenocarcinoma is higher than 5% (figure 1).6,54”
From Early detection of pancreatic cancer (2020) · cites this paper as [6]
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- Authors
- Canto, M. I., Harinck, F., Hruban, R. H., Offerhaus, G. J., Poley, J.-W., Kamel, I., Nio, Y., Schulick, R. S., Bassi, C., Kluijt, I., Levy, M. J., Chak, A., Fockens, P., Goggins, M., & Bruno, M.
- Affiliations
- Johns Hopkins University (US)
- Erasmus MC (NL)
- Utrecht University (NL)
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
- Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
- University of Verona (IT)
- Amsterdam UMC Location University of Amsterdam (NL)
- Mayo Clinic (US)
- University Hospitals of Cleveland (US)
- Corresponding author
- Canto, Marcia Irene
- ORCID
- Venue
- Gut
- Publisher
- BMJ
- Published
- 2012-11-07
- Volume
- 62
- Issue
- 3
- Pages
- 339-347
- ISSN
- 0017-5749 (ISSN-L)
- 1468-3288
- PMC
- PMC3585492
- OpenAlex
- W2111705409
- Cited by
- 784
- References
- 88
- Citations by year
- 2026: 23 · 2025: 23 · 2024: 40 · 2023: 53 · 2022: 66 · 2021: 73 · 2020: 61 · 2019: 82 · 2018: 82 · 2017: 67 · 2016: 71 · 2015: 69 · 2014: 45 · 2013: 23 · 2012: 6
- FWCI
- 22.79
- Type
- journal article
- Language
- en
- Update notices
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- Gut (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, other-oa)
- Utrecht University Repository (Utrecht University) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, other-oa)
- RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
- Leiden Repository (Leiden University) (submittedVersion)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- National Cancer Institute (K24CA113433, P30CA006973)
- Topics
- Health Sciences › Medicine › Oncology › Pancreatic and Hepatic Oncology Research
- Health Sciences › Medicine › Surgery › Pancreatitis Pathology and Treatment
- Health Sciences › Medicine › Pathology and Forensic Medicine › Genetic factors in colorectal cancer
- Keywords
- pancreatic cancer screening, familial pancreatic cancer, genetic susceptibility, pancreatic intraepithelial neoplasia, intraductal papillary mucinous neoplasm, Peutz-Jeghers syndrome, BRCA2 mutation carriers, Lynch syndrome, endoscopic ultrasound, surveillance interval, surgical management, high-volume centers, multidisciplinary team, consensus recommendations
- MeSH terms
- Age Factors, Carcinoma, Follow-Up Studies, Humans, Mutation, Pancreatectomy, Pancreatic Neoplasms, Pedigree, Risk Factors, Treatment Outcome, Endosonography, Genetic Predisposition to Disease, Cholangiopancreatography, Magnetic Resonance, Early Detection of Cancer, Neoplasm Grading
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