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MRI Screening Protocol for Pancreatic Cancer as Surveillance for High Risk Family Members

About 10% of those diagnosed with pancreatic cancer (ductal adenocarcinoma of the pancreas) are found to have a reasonably strong pancreatic cancer family history or that of another genetic complex or syndrome which tends to include pancreatic cancer. Consequently, many family members often ask us or their medical teams what their risks are, and what measures might be taken to try and find pancreatic cancer earlier. There is no easy answer to this question as of yet. Various institutions have empirically begun to institute pancreatic cancer screening programs, often in conjunction with an attendant institution-based tumor registry. But, though research in these areas is proceeding (and pancreatic cancer tumor registries are growing in number) there is not yet a definitive answer regarding such surveillance.

We note then with interest the results of Swedish researchers including Professor Matthias Löhr from the Karolinska Institute / Karolinska University Hospital in Stockholm who published work in the June 15, 2015 edition of the JAMA Surgery journal (formerly, Archives of Surgery) in which the results of a prospective observational study using an MRI-based protocol for screening such family members were presented.

For a three year period beginning January 2010, relatives of patients with pancreatic cancer in their institution were evaluated by MRI and by looking for genetic mutations that are commonly found in pancreatic cancer. A total of 40 patients (family members) were enrolled in the study. The mean period for follow-up was 12.9 months. The number of relatives identified as possessing the common genetic mutations was 15, ranging stepwise from 5 related to one patient, down to one for another. The MRIs demonstrated 14 patients with intraductal papillary mucinous neoplasia (IPMN), and two patients with pancreatic adenocarcinoma. One additional patient was shown to have both a pancreatic cancer adenocarcinoma and an IPMN. Five patients required surgery. The additional 35 individuals remain in the surveillance program.

The researchers conclude that this MRI-based surveillance protocol appears to be working reasonably well. They acknowledge the limitations of interpretation due to the short duration of the study, but are continuing the program and the assessment of the program.

This study seems to us, given current tools, to be a reasonable early effort at establishing possible procedures and a baseline for following family members at high-risk for pancreatic cancer.

 

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Dale O’Brien, MD