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Medline ® Abstract for Reference 87

of 'Familial risk factors for pancreatic cancer and screening of high-risk patients'

Screening for pancreatic cancer in a high-risk population with serum CA 19-9 and targeted EUS: a feasibility study.
Zubarik R, Gordon SR, Lidofsky SD, Anderson SR, Pipas JM, Badger G, Ganguly E, Vecchio J
Gastrointest Endosc. 2011 Jul;74(1):87-95.
BACKGROUND: Earlier detection of pancreatic adenocarcinoma is needed.
OBJECTIVE: To determine whether early pancreatic neoplasia can be detected in a high-risk population by using CA 19-9 followed by targeted EUS.
DESIGN: Prospective cohort study.
SETTING: Two academic medical centers.
PATIENTS: Eligible patients met age criteria and had at least 1 first-degree relative with pancreatic adenocarcinoma.
INTERVENTIONS: A serum CA 19-9 was performed on all patients. EUS was performed if the CA 19-9 level was elevated. FNA of identified lesions was performed. Patients with pancreatic cancer detected by using this screening protocol were compared with patients presenting off-protocol for staging data. Medicare reimbursement rates were used to derive cost data.
MAIN OUTCOME MEASUREMENTS: Detection of early pancreatic neoplasia.
RESULTS: A total of 546 patients were enrolled. CA 19-9 was elevated in 27 patients (4.9%, 95% CI, 3.2%-7.1%). Neoplastic or malignant findings were detected in 5 patients (0.9%, 95% CI, 0.3%-2.1%), and pancreatic adenocarcinoma in 1 patient (0.2%, 95% CI, 0.005%-1.02%). The patient with pancreatic cancer detected as part of this protocol was 1 of 2 patients presenting to the University of Vermont with stage 1 cancer. The cost to detect 1 pancreatic neoplasia was $8431. The cost to detect 1 pancreatic adenocarcinoma was $41,133.
LIMITATIONS: The sample size is adequate only to demonstrate the feasibility of this approach.
CONCLUSIONS: Potentially curative pancreatic adenocarcinoma can be identified with this screening protocol. Stage 1 pancreatic cancer is more likely to be detected by using this screening protocol than by using standard means of detection.
Division of Gastroenterology, University of Vermont, Burlington, VT, USA. Richard.Zubarik@vtmednet.org