Pancreatic cancer surveillance in a high-risk cohort - Is it worth the cost?

Pancreatic adenocarcinoma is the 10th most common malignancy and 4th larges t cancer killer in adults. Earlier tumor detection through screening of hig h risk groups, presumably to increase the percentage of cases resectable fo r cure in these cohorts, has emerged as a prominent strategy to combat this disease. This article examines the feasibility of this strategy in patient s with hereditary pancreatic cancer (HPC) and hereditary pancreatitis (HP). Because of a variety of factors, specific cost projections for screening w ith HPC kindreds are problematic at best. Patients with HP exhibit a 53-fol d increased risk of pancreatic cancer, with a cumulative risk of 40% by age 70. The authors discuss the modalities available to screen this cohort and subsequently perform a theoretical cost analysis. The authors' findings su ggest that screening has the potential to be cost-effective only in heredit ary pancreatitis patients = 50 years-of-age. The most cost-effective option will likely combine an initial serologic test with hi sensitivity and a su bsequent serologic or pancreatic juice test sufficient specificity to act a s a "gatekeeper" to imaging with endoscopic ultrasound (EUS). Banking of bl ood and pancreatic juice samples should be mandatory in any screening proto col. The lower tumor yield in other high-risk groups (e.g., non-hereditary chronic pancreatitis) will effectively preclude the use of such screening p rotocols. The vast majority of patients will continue to present with unres ectable disease.