Healthy Patients Should Not Undergo Pancreatic Cancer Screening: USPSTF

The latest recommendation from the United States Preventative Task Force (USPSTF) advises against pancreatic cancer screening in patients “without obvious related signs or symptoms.” The updated statement was published in JAMA.

“Pancreatic ductal adenocarcinoma (referred to hereafter as pancreatic cancer) is an uncommon cancer with an age-adjusted annual incidence of 12.9 cases per 100 000 person-years. However, the death rate is 11.0 deaths per 100 000 person-years because the prognosis of pancreatic cancer is poor,” according to the report. “Although its incidence is low, pancreatic cancer is the third most common cause of cancer death in the United States.”

The USPSTF previously reviewed evidence and released a “D”-grade recommendation in 2004 for pancreatic cancer screening in low-risk patients. According to the USPSTF website, a “D” letter grade means the USPSTF “discourage[s] the use of this service.”

“The USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits,” the site states.

In its statement the USPSTF wrote, “Using a reaffirmation deliberation process, the USPSTF concludes that there is no new evidence that warrants a change in the prior D recommendation and reaffirms its previous conclusion that the potential benefits of screening for pancreatic cancer in asymptomatic adults do not outweigh the potential harms.”

The updated recommendation only applies to low-risk patients. Patients with an inherited genetic syndrome such as Peutz-Jeghers syndrome or hereditary pancreatitis or whose families have a history of pancreatic cancer are not included in this recommendation. Patients with lesser impactful risk factors like new-onset diabetes, preexisting diabetes, older age, cigarette smoking, obesity, or a history of chronic pancreatitis are included in the latest recommendation.

Evidence Summary

The USPSTF came to its latest recommendation by reviewing current available data obtained through MEDLINE, PubMed, and the Cochrane Collaboration Registry of Controlled Trials. The outcomes were published separately in JAMA. Studies were published from January 2002 through April 27, 2018. “Studies of adults with or without risk factors for pancreatic adenocarcinoma (eg, family history of pancreatic cancer, personal history of new-onset diabetes) undergoing imaging-based screening; studies of treatment for adults with screen-detected or asymptomatic pancreatic adenocarcinoma,” according to the report. Possible abstracts and full-length studies were evaluated by two independent investigators.

The final analysis included 13 “fair-quality prospective cohort screening studies (N = 1317) conducted predominantly in populations at high familial risk for pancreatic adenocarcinoma.” None of the studies addressed how screening impacts morbidity or mortality, or how effective treatment is for screen-detected pancreatic adenocarcinoma. Diagnostic yields were explored in all 13 studies, ranging from zero to 75 cases per 1,000 persons. Of 1,156 adults at high familial risk, there were 18 cases of pancreatic adenocarcinoma, compared to zero cases of 161 average-risk adults. Eight studies found no significant harms associated with initial screening, and two studies observed no psychosocial harms associated with screening.

The report concluded: “Imaging-based screening in groups at high familial risk can detect pancreatic adenocarcinoma with limited evidence of minimal harms. However, the effect of screening on morbidity and mortality in groups at high familial risk has not been studied, and no data are available in average-risk populations. There is limited evidence to assess benefits or harms of surgical intervention for screen-detected pancreatic adenocarcinoma.”

Source: Jama: Screening for Pancreatic Cancer Updated Evidence Report and Systematic Review for the US Preventive Services Task Force; Screening for Pancreatic Cancer US Preventive Services Task Force Reaffirmation Recommendation Statement