The Final USPSTF Recommendations on Pancreatic Cancer Screening
SUMMARY:
Pancreatic cancer is uncommon but remains the third most common cause of cancer death in the US. The USPSTF predicts that pancreatic cancer may become the 2nd most common cause due to (1) increasing incidence (2) improved detection (3) increased survival from other cancers due to new therapies. The last recommendation on this topic was in 2004 and therefore the USPSTF sought to update guidance based on the latest evidence review
Recommendations
The USPSTF recommends against screening for pancreatic cancer in asymptomatic adults (D recommendation)
The USPSTF does not recommend screening for pancreatic cancer in the general population using any method
Note: Applicable population: Asymptomatic adults not known to be at high risk of pancreatic cancer
Benefits
- Benefits are considered no greater than ‘small’
- Pancreatic cancer incidence is low in the general population
- age-adjusted annual incidence of 12.9 cases per 100,000 person-years
- Accuracy of current candidate screening tests remains uncertain
- USPSTF does not recommend screening using “any method”
- Pancreatic cancer has a poor prognosis even when treated early
- Pancreatic cancer incidence is low in the general population
Harms
- Potential harms are considered at least ‘moderate’
- Potential for false-positive results
- Consequent harms of treatment: Pancreatectomy carries significant morbidity and mortality
KEY POINTS:
- This recommendation does apply to individuals at high risk, e.g., carriers of pathogenic mutations for genetic syndromes or with a significant family history
- Potential early detection screening tests were reviewed and were found to be not sufficiently accurate to apply to general populations
- Imaging-based: CT scan | MRI | Endoscopic Ultrasound (EUS)
- Most studies performed in high risk population
- Biomarkers: No validated biomarkers are currently available
- Imaging-based: CT scan | MRI | Endoscopic Ultrasound (EUS)
- Early Detection and Treatment
- No studies in the general population have demonstrated benefit to early detection and treatment
- Pancreatic intraepithelial neoplasia: Common finding that does not typically progress to cancer
- Risk of overdiagnosis and overtreatment
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