High Risk Pancreas Cancer Screening

Routine population screening for pancreatic cancer, similar to routine colon cancer or breast cancer screening, is not recommended due the limitations of the available screening tools and the fact that pancreatic cancer is rare. However, current evidence suggests that screening may prove useful in individuals at high risk by detecting cancers at an earlier, treatable stage. The optimal screening method and interval for pancreatic cancer is still unclear but favors use of both endoscopic ultrasound (EUS) and MRI imaging. However, consideration of screening, particularly in the setting of a research study, is recommended for individuals with a significantly increased risk to develop pancreatic cancer beginning at age 50 or 10 years younger than the youngest relative with pancreatic cancer or at age 30 for individuals with Peutz-Jeghers Syndrome.

Screening should be considered for individuals meeting the following criteria:

High Risk Group 2 (familial pancreatic cancer relatives):

  1. >55 years old or 10 years younger than the age of youngest relative with pancreatic cancer, and
  2. come from a family with 2 or more members with a history of pancreatic cancer (2 of which have a first-degree relationship consistent with familial pancreatic cancer), and
  3. have a first-degree relationship with at least one of the relatives with pancreatic cancer.

If there are 2 or more affected blood relatives, at least 1 must be a first-degree relative of the individual being screened

High Risk Group 3 (Group 1 germline mutation carriers with an associated with an estimated lifetime risk of pancreatic cancer of ~10% or higher):

  1. >50 years old or 10 years younger than the age of the youngest relative with pancreatic cancer,and
  2. The Patient is a carrier of a confirmed FAMMM (p16/CDKN2A), BRCA2, or PALB2 mutation, and there is 1 or more pancreatic cancer diagnoses in the family, one of whom is a first- or second-degree relative of the subject to be screened.

High Risk Group 4 (Group 2 germline mutation carriers with an associated with an estimatedlifetime risk of pancreatic cancer of ~5%):

  1. >55 years old or 10 years younger than the age of the youngest relative with pancreatic cancer, and
  2. The patient is a carrier of a confirmed BRCA1, or HNPCC (hereditary non-polyposiscolorectal cancer or Lynch syndrome, hMLH1, hMSH2, PMS1, hMSH6, EpCAM) gene mutation, and there is >1 pancreatic cancer in the family, one of whom is a first- or second-degree relative of the subject to be screened.
High risk group 5 (hereditary pancreatitis) with confirmed gene mutations that predispose tochronic pancreatitis, such as PRSS1, PRSS2, CTRC) and age 50 years or older (these patientshave an estimated lifetime risk for pancreatic cancer of 40%) or twenty-years since their first attack of pancreatitis, whichever age is younger.
  1. At least 30 years old, and
  2. at least 2 of 3 criteria diagnostic of Peutz-Jeghers syndrome (characteristic intestinalhamartomatous polyps, mucocutaneous melanin deposition, or family history of Peutz-Jeghers syndrome), or,
  3. known STK11 gene mutation carrier

At the Yale Pancreas Disease Program, and the Yale Cancer Genetics and Prevention Program we offer expert multidisciplinary evaluation, diagnosis, and treatment of patients  at high risk of developing pancreatic cancer.