The U.S. Preventive Services Task Force has finalized its most recent recommendation against screening for pancreatic cancer in asymptomatic adults at average risk.
The Task Force used a reaffirmation deliberation process to update its 2004 recommendation on this topic, meaning that only a very high level of evidence would justify a change in its previous D grade. The final recommendation and the updated evidence report and systematic review were published by JAMA on Aug. 6.
The systematic review included 13 fair-quality prospective cohort screening studies involving 1,317 patients, most of whom were at high familial risk for pancreatic cancer. None of the 13 studies reported on whether screening for pancreatic cancer affected morbidity or mortality or on the effectiveness of treatment for such cancer detected by screening. Diagnostic yield ranged from 0 to 75 cases per 1,000 persons for endoscopic ultrasound, MRI, and/or CT. Eighteen cases of pancreatic cancer were detected overall in 1,156 adults with increased familial risk, and 0 cases were detected in 161 adults at average risk. No serious physical or psychosocial harm was found in studies that included such outcomes, and evidence of surgical harm was limited.
Based on the updated evidence report and review, the Task Force concluded that there is no evidence that screening for pancreatic cancer or treating screening-detected disease improves disease-specific morbidity or mortality or all-cause mortality in adults with no symptoms who are at average risk. It noted that its recommendation does not apply to patients at high risk due to an inherited genetic syndrome, such as hereditary pancreatitis or Peutz-Jeghers syndrome, or due to a family history of pancreatic cancer. The Grade D recommendation does apply to patients with other lesser risk factors, such as new-onset diabetes, older age, cigarette smoking, obesity, pre-existing diabetes, or a history of chronic pancreatitis, as they are considered part of the general population, the Task Force said.
An accompanying editorial, also published Aug. 6 by JAMA, agreed with the Task Force's recommendation but noted that if the surveillance population included more patients with associated germline mutations, familial pancreatic cancer, and possibly new-onset diabetes, the balance might shift in favor of screening in these groups. “Further study is needed to fully define the population who should be screened and by what optimal strategy to improve outcomes and minimize harms resulting from pancreatic cancer surveillance in individuals at increased risk,” the editorialists wrote.