🌟Pancreatic cancer (PC) Screening by @MajumderShounak #IMPACT #gitwitter

Why care about screening for PC?
10th leading cancer 🦀diagnosis in 🇺🇸 but 3rd leading cancer☠️with 5-year survival is only 11%

🎯Current recommendations suggest against PC screening unless "high-risk"

Define "High-risk individual" (HRI)?
1⃣Age
2⃣Fam hx of PC (dx age, relationship)
3⃣Germline mutations

‼️Familial PC = ≥2 first-degree relatives (FDR)
☠️If 2 FDR 6x risk
☠️If 3 FDR 32x risk

🦀Genetic mutations assoc with PC (5.5% cases) - CDKN2A, TP53, MLH1, BRCA2, ATM,
BRCA1

🔍Begin screening age 50 or 10 years younger than the earliest relative affected by PC

Peutz-Jeghers Syndrome (STK11/LKB1)—Age 35
Hereditary Pancreatitis (PRSS1)—Age 40
Familial atypical multiple mole melanoma syndrome (CDKN2A)—Age 40

🎯Screening modalities: MRI and EUS are used in combo as the preferred screening modalities

🎯If no worrisome findings in an asymptomatic individual repeat surveillance every 12 months

🌟PC risk in chronic pancreatitis (CP)

🎯PC in CP is not a common event but has ↑risk 22.6x

🎯PC incidence rates appear to ↑ with CP duration and MPD dilation

‼️NCCN Guidelines-Consider screening with EUS/MRI 20yrs after CP onset or at age 40 years whichever is earlier

🌟PC and Diabetes Mellitus

🎯Hyperglycemia is noted up to 3yrs before PC dx
🎯1% NOD patients age>50yrs were dx with PC within 3yrs

‼️Currently screening for PC is NOT recommended in patients with NOD

☠️Ca19.9 has ↓ sensitivity

👎60% sensitivity at 99% specificity within 0-6 months before diagnosis
👎50% sensitivity at 99% specificity for early-stage cases

🎯Future steps: Minimally invasive and ↑ sensitive biomarkers & AI-enabled imaging for detecting early-stage PC