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Surveillance for Hereditary Pancreatic Cancer: A High-volume Center Experience
*Daniel Wong, *Mariam Eskander, *Jill Krejdovsky, *Lindsay A. Bliss, *Chun Li, *Susanna WL. de Geus, *Sing Chau Ng, *Mandeep Sawhney, *Steven D. Freedman, *Nadine Tung, Jennifer F. Tseng
Beth Israel Deaconess, Boston, MA
Objective: To characterize the surveillance strategies and oncologic outcomes of patients at risk of pancreatic cancer in a tertiary medical center.
Design: Retrospective chart review.
Setting: Academic hospital
Patients: Patients with a family history or known genetic predisposition to pancreatic cancer, referred to genetic counseling from 2000-2014.
Interventions: N/A
Main Outcome Measures: Rates of screening, surveillance, interventions, cancer
Results: 78 individuals identified with median follow-up of 4.7 years. Median age at risk assessment was 50; 35.9% were Ashkenazi Jewish and 47.4% had a previous oncologic history. All had genetic testing and 64 (82.1%) were positive (most common BRCA1/2, Lynch genes.) Five (6.4%) already had pancreatic cancer at time of genetic counseling; 29 (39.7%) of the remaining 73 underwent initial screening and of those, 22 (75.9%) continued with surveillance: a combination of CT, MRCP, and endoscopic ultrasound (EUS) primarily managed by surgeons. 14 (48.3%) patients deviated from intended schedule (mostly due to access issues and loss to follow-up.) Potentially pre-malignant stigmata identified in 11/29 (37.9%) undergoing screening and 6/22 (27.3%) after further surveillance. Two patients underwent ERCP and another an EUS/FNA, who went on to receive a robotic Whipple for suspected combined type IPMN, found to be stage IIB cancer on resection. An additional patient lost to screening for 8 years was subsequently diagnosed with stage III cancer, treated with chemotherapy.
Conclusions: Our center utilizes an MRI and EUS-based surveillance program. The high incidence of cystic lesions in previous studies of high risk individuals was not duplicated. Further investigation into risk factors for development of pre-malignant lesions and the optimal surveillance strategy is needed in this high risk population.
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