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Screening for Pancreatic Cancer: Why, How, and Who?

Poruk, Katherine E. BS, BA*; Firpo, Matthew A. PhD; Adler, Douglas G. MD; Mulvihill, Sean J. MD

doi: 10.1097/SLA.0b013e31825ffbfb
Reviews

Pancreatic cancer is the fourth most common cause of cancer mortality in the United States, with 5-year survival rates for patients with resectable tumors ranging from 15% to 20%. However, most patients presenting with distant metastases, are not resectable, and have a 5-year survival rate of close to 0%. This demonstrates a need for improved screening to identify pancreatic cancer while the tumor is still localized and amenable to surgical resection. Studies of patients with pancreatic tumors incidentally diagnosed demonstrate longer median survival than tumors discovered only when the patient is symptomatic, suggesting that early detection may improve outcome. Recent evidence from genomic sequencing indicates a 15-year interval for genetic progression of pancreatic cancer from initiation to the metastatic stage, suggesting a sufficient window for early detection. Still, many challenges remain in implementing effective screening. Early diagnosis of pancreatic cancer relies on developing screening methodologies with highly sensitive and specific biomarkers and imaging modalities. It also depends on a better understanding of the risk factors and natural history of the disease to accurately identify high-risk groups that would be best served by screening. This review summarizes our current understanding of the biology of pancreatic cancer relevant to methods available for screening. At this time, given the lack of proven benefit in this disease, screening efforts should probably be undertaken in the context of prospective trials.

Pancreatic adenocarcinoma is a largely fatal disease with increased survival for patients with localized disease compared with those with distant metastases. A critical evaluation of early detection strategies is presented in light of results from more common cancers. Improved outcomes may be attained by focusing screening on high-risk groups; however, these efforts are as yet unproven.

*Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT; and

Departments of Surgery

Internal Medicine, Division of Gastroenterology and Hepatology, University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, UT.

Reprints: Matthew A. Firpo, PhD, Department of Surgery, 3B110 SOM, University of Utah, 30 N 1900 E, Salt Lake City, UT 84132. E-mail: matt.firpo@hsc.utah.edu.

Disclosure: This work was supported in part by research grants from the National Institutes of Health P30CA042014 to the Huntsman Cancer Institute for support of core facilities and U01CA15165 and R33CA155586 (to S.J.M.). K.E.P was supported in part by the Ruth L. Kirschstein National Research Service Award from the National Institutes of Health (T35HL007744).

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.annalsofsurgery.com).

© 2013 Lippincott Williams & Wilkins, Inc.