© 2004 by Oxford University Press
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© 2004 Oxford University Press
NEWS |
Screening Methods May Offer Early Diagnosis of Pancreatic Cancer
At least 10% of pancreatic cancers occur in people genetically predisposed to develop pancreatic neoplasms, but there has been no way to detect the disease before it became clinically apparent. Now Johns Hopkins University investigators have defined possible screening methods to detect early forms of pancreatic cancer in this population.
The Cancer of the Pancreas Screening 2 (CAPS2) project included people from families in which pancreatic cancer had affected three or more first-degree relatives as well as people with Peutz Jeghers syndrome (PJS), a rare inherited disorder whose features include a high rate of pancreatic cancer.
The study involved 78 high-risk patients and 140 control subjects. Of the high-risk individuals, 72 had more than one first-degree relative with pancreatic cancer and six had PJS, said Michael Goggins, M.D., associate professor of pathology, medicine, and oncology at Johns Hopkins.
Except for one patient with a past history of acute pancreatitis, all high-risk patients had no symptoms involving the pancreas, and control subjects had no personal or family history of pancreatic disease or pancreatic cancer.
In nine of the 78 high-risk patients, endoscopic ultrasound revealed cystic masses associated with dilated pancreatic ducts, Goggins reported at the Pancreatic Cancer 2004 meeting in San Francisco. Only three of these masses were also seen on spiral CT interpreted by experienced radiologists, he added. No mass lesions were seen in the healthy control subjects.
Five of the nine patients with cystic masses have undergone surgery. Four—three from pancreatic cancer kindreds and one with PJS—had intraductal papillary mucinous neoplasms (IPMNs). The patient with PJS also had carcinoma in situ. The fifth patient had a pancreatic intraepithelial neoplasia lesion only.
In addition, three nonpancreatic neoplasms were found in the high-risk group: a stage 1 renal cell carcinoma and two ovarian mucinous cystadenomas, all of which were treated surgically.
"We were trying to detect early neoplasia—in other words, IPMNs and [pancreatic intraepithelial neoplasias], as well as asymptomatic small cancers," Goggins said. "We found more IPMNs than we expected, possibly because familial [pancreatic cancer] evolves through an IPMN stage more frequently than we thought, which is fantastic because we can detect IPMNs, which are curable more readily."
Marcia Irene Canto, M.D., associate professor of medicine at Johns Hopkins and lead investigator of the study, said she urges the pancreatic cancer community to set up a consortium to confirm these results in a nationwide study.
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J Natl Cancer Inst 2004 96: 1570-1572.
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