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August 6, 2019

Screening for Pancreatic Cancer

JAMA. 2019;322(5):478. doi:10.1001/jama.2019.10776
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The US Preventive Services Task Force (USPSTF) has recently published recommendations on screening for pancreatic cancer in adults.

What Is Pancreatic Cancer?

Pancreatic cancer is a rare but highly lethal type of cancer. Nearly all people who have pancreatic cancer die of it; it is the third leading cause of cancer death in the United States. Symptoms of pancreatic cancer can include yellowing of the skin (jaundice), weight loss, and pain in the abdomen or back. However, many cases of pancreatic cancer do not show symptoms until later stages, when the cancer has spread into other organs such as the liver. Treatment for pancreatic cancer involves surgery if it is found in the earlier stages, as well as chemotherapy and sometimes radiation therapy.

What Tests Are Used to Screen for Pancreatic Cancer?

Pancreatic cancer can be detected by an imaging test of the abdomen (where the pancreas is located), such as with computed tomography (CT), magnetic resonance imaging (MRI), or a special type of ultrasound via a scope that goes through the mouth and the stomach into the small intestine (endoscopic ultrasound). Although some blood tests can have abnormal results in pancreatic cancer, these have not been shown to be accurate enough to diagnose the disease.

What Is the Patient Population Under Consideration for Screening for Pancreatic Cancer?

This USPSTF recommendation applies to adults who have no signs or symptoms of pancreatic cancer and who are not at higher risk of pancreatic cancer because of strong family history or having certain inherited genetic syndromes. A strong family history means having 2 or more first-degree relatives (parents, brothers, sisters, or children) who have had pancreatic cancer.

What Are the Potential Benefits and Harms of Screening for Pancreatic Cancer?

The goal of screening for cancer is to find it early and prevent death from that cancer. Unfortunately, for pancreatic cancer, there is no evidence that screening-detected early-stage cases are any less lethal than cases that are detected later. Therefore, the benefits of screening for pancreatic cancer are small. Given how uncommon pancreatic cancer is, screening for it is more likely to yield false-positive results. These false-positive results are associated with some harm, as they lead to further unnecessary testing that may include invasive procedures and sometimes even surgery.

How Strong Is the Recommendation to Screen for Pancreatic Cancer?

Based on current evidence, the USPSTF concludes that the potential benefits of screening for pancreatic cancer in asymptomatic adults do not outweigh the potential harms.

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Article Information

Conflict of Interest Disclosures: None reported.

Source: US Preventive Services Task Force. Screening for pancreatic cancer: US Preventive Services Task Force reaffirmation recommendation statement [published August 6, 2019]. JAMA. doi:10.1001/jama.2019.10232