Management of patients with increased risk for familial pancreatic cancer: updated recommendations from the International Cancer of the Pancreas Screening (CAPS) Consortium

Michael Goggins, Kasper Alexander Overbeek, Randall Brand, Sapna Syngal, Marco Del Chiaro, Detlef K. Bartsch, Claudio Bassi, Alfredo Carrato, James Farrell, Elliot K. Fishman, Paul Fockens, Thomas M. Gress, Jeanin E. Van Hooft, R. H. Hruban, Fay Kastrinos, Allison Klein, Anne Marie Lennon, Aimee Lucas, Walter Park, Anil RustgiDiane Simeone, Elena Stoffel, Hans F.A. Vasen, Djuna L. Cahen, Marcia Irene Canto, Marco Bruno

Research output: Contribution to journalReview article

Abstract

Background and aim The International Cancer of the Pancreas Screening Consortium met in 2018 to update its consensus recommendations for the management of individuals with increased risk of pancreatic cancer based on family history or germline mutation status (high-risk individuals). Methods A modified Delphi approach was employed to reach consensus among a multidisciplinary group of experts who voted on consensus statements. Consensus was considered reached if ≥75% agreed or disagreed. Results Consensus was reached on 55 statements. The main goals of surveillance (to identify high-grade dysplastic precursor lesions and T1N0M0 pancreatic cancer) remained unchanged. Experts agreed that for those with familial risk, surveillance should start no earlier than age 50 or 10 years earlier than the youngest relative with pancreatic cancer, but were split on whether to start at age 50 or 55. Germline ATM mutation carriers with one affected first-degree relative are now considered eligible for surveillance. Experts agreed that preferred surveillance tests are endoscopic ultrasound and MRI/magnetic retrograde cholangiopancreatography, but no consensus was reached on how to alternate these modalities. Annual surveillance is recommended in the absence of concerning lesions. Main areas of disagreement included if and how surveillance should be performed for hereditary pancreatitis, and the management of indeterminate lesions. Conclusions Pancreatic surveillance is recommended for selected high-risk individuals to detect early pancreatic cancer and its high-grade precursors, but should be performed in a research setting by multidisciplinary teams in centres with appropriate expertise. Until more evidence supporting these recommendations is available, the benefits, risks and costs of surveillance of pancreatic surveillance need additional evaluation.

Original languageEnglish (US)
Pages (from-to)7-17
Number of pages11
JournalGut
Volume69
Issue number1
DOIs
StatePublished - Jan 1 2020

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Keywords

  • early detection
  • familial pancreatic cancer
  • genetic predisposition
  • pancreatic ductal adenocarcinoma
  • surveillance

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Goggins, M., Overbeek, K. A., Brand, R., Syngal, S., Del Chiaro, M., Bartsch, D. K., Bassi, C., Carrato, A., Farrell, J., Fishman, E. K., Fockens, P., Gress, T. M., Van Hooft, J. E., Hruban, R. H., Kastrinos, F., Klein, A., Lennon, A. M., Lucas, A., Park, W., ... Bruno, M. (2020). Management of patients with increased risk for familial pancreatic cancer: updated recommendations from the International Cancer of the Pancreas Screening (CAPS) Consortium. Gut, 69(1), 7-17. https://doi.org/10.1136/gutjnl-2019-319352