Early detection of pancreatic cancer

We recently reported the long-term outcomes of pancreas surveillance of patients in the Cancer of Pancreas Screening (CAPS) program, including the twenty-plus year experience at Johns Hopkins Hospital and the results of the multicenter (CAPS5) study which began in 2014. The primary endpoint of this analysis was the stage distribution of pancreatic ductal adenocarcinoma (PDAC) detected and the secondary endpoint was survival. Ten patients were diagnosed with PDAC in the CAPS5 cohort; 26 overall in the CAPS program (since 1998). 78% of those in CAPS5 had a Stage I PDAC at the time of surgical resection. In the entire CAPS cohort, 19 of the 26 PDAC cases diagnosed were detected within surveillance, 58% of whom had Stage I. In contrast, the majority of patients diagnosed with PDAC who do not maintain annual surveillance had advanced-stage disease at diagnosis. Median overall survival is 9.8 years among those with PDAC detected during surveillance versus 1.5 years for patients diagnosed with PDAC outside surveillance. These impressive results mirror what has been observed for patients diagnosed with sporadic forms of Stage I PDAC and may improve further with the emerging impact of neoadjuvant therapy. Unanswered questions for pancreas surveillance include the role of emerging multi-cancer detection blood tests, the optimal surveillance intervals for patients with different risk levels, the factors that influence compliance with surveillance and the development of more refined risk estimate tools.