Systematic Reviews
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 28, 2015; 21(28): 8678-8686
Published online Jul 28, 2015. doi: 10.3748/wjg.v21.i28.8678
Screening for pancreatic cancer in familial high-risk individuals: A systematic review
Chao Lu, Cheng-Fu Xu, Xing-Yong Wan, Hua-Tuo Zhu, Chao-Hui Yu, You-Ming Li
Chao Lu, Cheng-Fu Xu, Xing-Yong Wan, Hua-Tuo Zhu, Chao-Hui Yu, You-Ming Li, Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Author contributions: Lu C and Xu CF contributed equally to this work; Lu C designed the research; Xu CF and Wan XY performed the research; Zhu HT contributed analytic tools. Lu C analyzed the data; Lu C and Xu CF wrote the paper; Yu CH and Li YM revised the manuscript.
Conflict-of-interest statement: Nobody has received fees for serving as a speaker. Nobody has received research funding. Xu CF, Yu CH, Li YM are employees of The First Affiliated Hospital, College of Medicine, Zhejiang University. Nobody owns stocks. Nobody owns a patent.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: You-Ming Li, Professor, Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou 310003, Zhejiang Province, China.
Telephone: +86-571-87236532 Fax: +86-571-87236611
Received: December 23, 2014
Peer-review started: December 25, 2014
First decision: March 10, 2015
Revised: April 3, 2015
Accepted: June 15, 2015
Article in press: June 16, 2015
Published online: July 28, 2015

AIM: To analyze the benefits and harms of pancreatic cancer screening in familial high-risk individuals (HRIs).

METHODS: Studies were identified by searching PubMed, EBSCO, and the Cochrane database from database inception to June 2014. We also obtained papers from the reference lists of pertinent studies and systematic reviews. English-language trials and observational studies were searched. The key words used as search terms were “screening” and “surveillance”. Cost-effectiveness, diagnostic rate, survival rate, mortality and adverse events were the outcomes of interest. Age, sex, lifestyle and other confounding factors were also considered. However, anticipating only a few of these studies, we also included observational studies with or without control groups. We also included studies concerning the anxiety associated with pancreatic cancer risk and other psychological changes in familial HRIs. We extracted details on study design, objectives, population characteristics, inclusion criteria, year of enrollment, method of screening, adjusted and unadjusted mortality, cost-effectiveness and adverse events from the included studies. Studies were assessed using the Reporting of Observational studies in Epidemiology (STROBE) checklist.

RESULTS: Sixteen studies on pancreatic cancer screening were included. Five studies included control groups, nine were observational studies without control groups, and the other two studies investigated the worry associated with pancreatic cancer risk. We found that pancreatic cancer screening resulted in a high curative resection rate (60% vs 25%, P = 0.011), longer median survival time (14.5 mo vs 4 mo, P < 0.001), and higher 3-year survival rate (20% vs 15.0%, P = 0.624). We also found that familial HRIs had a higher diagnostic rate of pancreatic tumors than controls (34% vs 7.2%, P < 0.001). In patients who underwent regular physical examinations, more stage I pancreatic cancers were observed (19% vs 2.6%, P = 0.001). In addition, endoscopic ultrasonography, which was the main means of detection, diagnosed 64.3% of pancreatic cancers. In comparison, endoscopic retrograde cannulation of the pancreas, magnetic resonance imaging, and computed tomography diagnosed 28.6%, 42.9%, and 21.4%, respectively. For mass lesions, instant surgery was recommended because of the beneficial effects of post-operative chemotherapy. However, in patients with intraductal papillary mucinous neoplasms, we did not find a significant difference in outcome between surgery and follow-up without treatment. Moreover, pancreatic cancer screening in familial HRIs had a greater perceived risk of pancreatic cancer (P < 0.0001), higher levels of anxiety regarding pancreatic cancer (P < 0.0001), and increased economic burden.

CONCLUSION: Pancreatic cancer screening in familial HRIs is associated with a higher detection rate and longer survival, although screening may influence psychological function and increase the economic burden.

Keywords: Pancreatic cancer, Screening, Benefit, Familial high-risk individuals, Pancreatic tumor

Core tip: Pancreatic cancer is a fatal disease with a five-year survival rate of less than 5%. The early diagnosis of pancreatic cancer is essential. Individuals with a family history of pancreatic cancer have an increased risk of developing the disease. To date, no study has systematically and comprehensively reported on pancreatic cancer screening in familial high-risk individuals. Here, for the first time, we performed a systematic review to determine whether screening for pancreatic cancer in familial high-risk individuals can detect early stage pancreatic cancer and prolong survival or reduce the negative effects of this disease.