NO USE OF PANCREATIC CANCER SCREENING

The US Preventive Services Task Force (Task Force) has the nixed the idea of screening for pancreatic cancer.

In a new draft recommendation statement and evidence review, the Task Force has given a D recommendation to pancreatic cancer screening. This means that for adults who are not at high risk for this disease and who do not show any signs or symptoms, the Task Force recommends against screening.

The new draft recommendation is an update of the 2004 final recommendation on the same topic and is consistent with the earlier recommendation.

"Although pancreatic cancer is rare, it is a devastating disease with low survival rates," said Task Force member Chyke Doubeni, MD, MPH, who is also the Harrison McCrea Dickson, MD, and Clifford C. Baker, MD, Presidential Professor and an associate professor of epidemiology at the University of Pennsylvania School of Medicine, Philadelphia.

"Unfortunately, we do not currently have an effective test to screen for pancreatic cancer," Doubeni noted in a statement.

Screening for pancreatic cancer in the general population is not recommended by any major medical organization. The American College of Gastroenterology conditionally recommends surveillance for certain high-risk individuals and suggests that surveillance be performed in experienced centers, ideally under research conditions.

The draft recommendation statement and draft evidence review on screening for pancreatic cancer will be posted for public comment on the Task Force Web site. Public comments will be accepted through March 4.

No Evidence for Accuracy of Screening Tests

Although a relatively uncommon cancer, pancreatic cancer is the third most common cause of cancer death in the United States, with an overall 5-year survival rate of 8.5%. The intervention most likely to improve survival is surgery, but only for patients with early-stage disease whose tumor is amenable to surgical resection. Even then, the median survival for early, stage I pancreatic cancer is 36 months, according to the Task Force.

Currently, most cases of pancreatic cancer are detected at an advanced stage when surgical resection is not likely to be beneficial, so there has been growing interest in identifying methods of early detection. However, the Task Force did not find any evidence that screening for pancreatic cancer improves patient outcomes.

In their review, the Task Force did not find any evidence for the accuracy of imaging-based screening tests, including CT, MRI, or endoscopic ultrasonography (EUS), for pancreatic cancer. There were no studies available that reported on the sensitivity or specificity of CT, MRI, or EUS as screening tests for this disease.

The Task Force also found no evidence that screening for pancreatic cancer or treatment of screen-detected pancreatic cancer improves any related outcomes, including disease-specific morbidity, disease-specific mortality, or all-cause mortality.

The Task Force notes that, owing to the low incidence of pancreatic cancer in the general population, the uncertain accuracy of screening tests, and the poor prognosis for patients with pancreatic cancer even when treated at an early stage, they "found adequate evidence to bound the benefits of screening for pancreatic cancer in asymptomatic adults as no greater than small."

Harms vs Benefit

The Task Force found that there was adequate indirect evidence to "bound the magnitude of the harms of screening for pancreatic cancer and treatment of screen-detected pancreatic cancer as at least moderate," based on the potential harms that could occur from false positive results and the harms of treatment. For example, some tests are invasive and can lead to complications, such as pancreatitis. Thus, the Task Force reaffirmed the 2004 conclusion that the potential benefits of screening asymptomatic adults at normal risk do not outweigh the potential harms.

"New effective screening tests are needed that can find pancreatic cancer earlier," said Task Force member Chien-Wen Tseng, MD, MPH, MSEE, a professor and the associate research director in the Department of Family Medicine and Community Health at the University of Hawaii John A. Burns School of Medicine, Honolulu, in a release. "We also need better treatments that can lead to improved survival or a cure with fewer harms."