Short-term results of an MRI-based screening program for patients at high risk of pancreatic cancer, published online in JAMA Surgery, showed the program was able to identify pancreatic lesions in 40 percent of patients, ultimately leading to surgery in five patients.
While the study population was not large and the study time was relatively short, the results show the potential benefits of a screening program for at-risk patients.
“An MRI-based protocol for the surveillance of individuals at risk for developing pancreatic cancer seems to detect cancer or premalignant lesions with good accuracy,” wrote authors Marco Del Chiaro, MD, PhD, of the Karolinska Institute in Stockholm, and colleagues. “The exclusive use of MRI can reduce costs, increase availability and guarantee the safety of the individuals under surveillance compared with protocols that are based on more aggressive methods.”
The study included 40 patients (24 women) with an average age of 49.9 years, who were referred based on genetic risk of developing pancreatic cancer between Jan. 1, 2010, and Jan. 31, 2013. Risk was determined by family history and the presence of common genetic mutation associated with pancreatic cancer. A total of 38 patients had a family history of the disease, and several patients had BRCA2, BRCA1 or p16 gene mutations.
The average follow-up was 12.9 months, and MRI was repeated after one year if initial screening was negative. Screening was repeated at six months if there were unspecific findings or findings that did not indicate surgery.
MRI-based screening found pancreatic lesions in 16 patients; intraductal papillary mucinous neoplasia, which might progress to invasive cancer, in 14 patients; and pancreatic ductal adenocarcinoma in two patients. Of the patients requiring surgery, three were referred for pancreatic ductal adenocarcinoma and two for intraductal papillary mucinous neoplasia.
In an associated commentary, Mark S. Talamonti, MD, of the NorthShore University HealthSystem in Evanston, Ill., explained that pancreatic cancer is diagnosed in only 10 percent of patients with syndromic risk factors or a family history of the disease. The vast majority of diagnoses are sporadic cancers with no known risk factors, creating a problem for early detection.
“Population screening with radiographic imaging or endoscopic procedures makes no clinical or economic sense for a cancer that represent only 3 percent of estimated new cancers each year; however, with an aging population, this most formidable of human cancers will only increase in incidence and frequency,” wrote Talamonti. “There is a clear and unequivocal need for affordable screening strategies based on reliable biomarkers and efficient imaging modalities.”