Recommendations for Pancreatic Cancer risk assessment and screening

Hi @markymarkfl

Thank you for posting this! My son and I both have the BRCA2 mutation and I have breast cancer for the second time. My surgeon talked me into an ECRP back in 2015 that I found very invasive, carried too much infection risk from what I was reading, cost me $1500 coinsurance and I had to have propofol. According to these guidelines, it is not recommended since we have no PC in the family and I had no symptoms. My current oncologist also brought up another screening 3 years ago and I declined. Now, I feel like I made the right choice. I would go for the less invasive route if I ever have to do it again.

@californiazebra , those are good points.

In an email I received today from PanCan, there was a link to this article about full-body MRI scans: https://pancan.org/news/full-body-mri-what-you-need-to-know/
but the more interesting link was in last sentence of the article:

"The U.S. Preventive Services Task Force currently recommends against screening for pancreatic cancer in asymptomatic adults not known to be at high risk for the disease." https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/pancreatic-cancer-screening

There is a ton of good data if you have time to open and read all of those links. They include discussion of some of the risks of overscreening and invasive screening, particularly in exchange for the statistical benefit obtained.

They do make the point in that report that it applies to the non-symptomatic population of people not known to be at risk, and that high-risk people (genetic conditions or first-degree relatives with PC) are excluded from the general recommendation.

I was disappointed to not find in those reports any updated info about the predictive value of CA19-9, CEA, DNA-based blood tests, or sudden-onset diabetes. They all have their limitations, but are all "yellow flags" that (IMHO) justify a deeper dive. Study conclusions are always based on statistics, but if you're an outlier patient on the bad extreme of their curves, it can be disastrous to be overlooked because you didn't fall closer to the center of the study population.

The linked task force recommendations obviously took several years to produce, and could only look at data produced several years prior. Unfortunately, that's part of the reason medical advances are so slow to roll out. I think/hope that by the time the next one comes out, it will use artificial intelligence to include a lot more input data and tease out new true-positive cases that human minds didn't think to look for.

As a gene carrier of BRCA1 I have encouraged family members to be screened, there are many options. ERCP is ancient historyA gastroenterologist who performs endoscopic ultrasound will recommend that procedure. This test will be dependent on the skill of the physician performing the procedure. Other options carry less risk. MRCP should be read by a radiologist expert in interpretation of the scan. Blood tests performed by major labs such as Quest etc probably would have the least variability. In my case, I did not know that BRCA1 was associated with pancreatic cancer. My ovarian cancer was diagnosed by an abnormal screening test which was being done for follow up. Saved my life. If I knew, I would have been more than happy to have a CA 19-9 every 3-6 months. Likely would have made treatment easier and maybe saved me the pancreatic insufficiency and 6 months of neoadjuvant chemotherapy. I have been fortunate to have a good response to chemo and am scheduled for surgery at MSKCC June 21st