ASGE has issued recommendations for pancreatic cancer screening among high-risk patients with a family history of the disease. The document was published in the journal Gastrointestinal Endoscopy.
Experts note that symptoms of pancreatic cancer usually occur in advanced stages, when the disease is inoperable. Moreover, its detection at stage I can improve five-year survival by 34-39%.
According to the guidelines, high-risk patients with a family history of pancreatic cancer are recommended to undergo screening with endoscopic ultrasound, endoscopic ultrasound with MRI, or MRI alone, depending on patient preference or test availability. Screening is also recommended for people with pathogenetic variants of BRCA1 and BRCA2.
Endoscopic ultrasound is preferred for initial screening and in patients with the highest risk of pancreatic cancer (for example, Peutz-Jeghers syndrome or familial atypical nevi and melanoma syndrome), in cases where endoscopic ultrasound can be combined with gastroscopy or colonoscopy (for example, with Lynch and Peutz-Jeghers syndromes) and if the patient is contraindicated for MRI.
Patients at high risk of adverse events during anesthesia or invasive procedures and those who prefer to avoid invasive procedures are recommended to use MRI. In addition, MRI is recommended if the study can be combined with other imaging methods (enterography for Peutz-Jeghers syndrome).
Screening is recommended annually. The age of its onset is determined individually depending on genetic characteristics.
Patients with pathogenetic variants BRCA2, BRCA1, PALB2, familial pancreatic cancer syndrome, with a pathogenetic variant with heterozygous mutations in the ATM gene and with Lynch syndrome, if pancreatic cancer is detected in first- and second-degree relatives, are advised to begin screening at the age of 50 years or 10 years earlier than the youngest age of detection of pancreatic cancer in relatives.
For familial atypical nevi and melanoma syndrome, screening should begin at age 40 years or 10 years earlier than the youngest age of detection of pancreatic cancer in relatives.
For Peutz-Jeghers syndrome, it is recommended to begin screening at the age of 35 years or 10 years earlier than the youngest age of detection of cancer in relatives.
For the autosomal dominant type of hereditary pancreatitis, screening should begin at age 40 years.