The Sol Goldman Pancreatic Cancer Research Center

Pancreatic Cancer Early Detection for High Risk Individuals


Pancreatic Cancer Early Detection Screening Program


Who should be screened for pancreatic cancer?

Pancreatic cancer screening is not appropriate for everyone, individuals without risk factors should not consider pancreas surveillance. However, screening for pancreatic cancer is recommended for people who have certain risk factors, including family history and certain genetic syndromes that increase susceptibility to pancreas cancer. Pancreas surveillance is also recommended in other instances such as new diagnoses of a pancreas cyst or lesion, if you are looking to learn more about following pancreatic cysts please follow the link to our Multidisciplinary Pancreatic Cyst Program.

At this point no early detection test has been shown to decrease incidence of pancreatic cancer related deaths. However, experts agree that individuals should undergo regular early detection tests to survey their pancreas when they have a relative risk of developing pancreatic cancer greater than fivefold of the risk in the general population. Regular surveillance uses medical imaging and endoscopic techniques to detect precancerous lesions or early pancreatic cancer that can be surgically removed.

Our physicians work with each person considering pancreatic cancer screening to evaluate your risk factors and develop a screening plan appropriate to you. The list below can help you identify if you would benefit from a clinical evaluation.

These definitions may be helpful to keep in mind as you read the following information:

  • FDR = First Degree relative
    Blood relatives in your immediate family: parents, children, and siblings (who you share both relatives with or are half siblings ok?)
  • SDR = Second Degree Relatives
    Aunts, uncles, grandparents, nieces and nephews
  • TDR = Third Degree Relatives
    First cousins, great-aunts and uncles
  • Germline mutation: An inherited genetic variation in DNA that you are born with

Family History

Pancreatic cancers sometimes run in families, patients who have a family history of pancreatic adenocarcinoma are more likely to develop this disease. If you have a family history of pancreatic cancer you should consider early detection tests based on the following guidelines:

  1. If you have more than one first degree relative (parents, siblings or children) who have developed pancreatic cancer.
  2. If you have first degree relatives (parents, siblings or children) who developed pancreas cancer before the age of 50.
  3. If one of your first degree relatives has developed pancreatic cancer and at least one of your second or third degree relatives has developed pancreatic cancer (i.e. One parent and one uncle, or a sibling and a cousin).
  4. If more than two of your second degree relatives (aunts, uncles, nieces and nephews) have developed pancreatic cancer.
  5. If you have three or more relatives of any relation who have developed pancreatic cancer

Genetic Variations

People who have a history of any of the following genetic variations and syndromes should consider pancreas cancer screening. Individuals who have or suspect they carry any of the following syndromes should meet with a physician experienced in the field to discuss pancreatic cancer screening guidelines. Clinical genetic testing is available to search for variations in these genes if you suspect a disease history in your family may be related to one of these genetic variants. For more information about the genetic syndromes associated with please visit NFPTR.

  1. Individuals who have the BRCA1, BRCA2 or PALB2 mutation and have at least one realtive affected by pancreatic cancer should consider pancreas screening. These mutations are associated with a history of breast and/or ovarian cancer and are more common amongst people of Ashkenazi Jewish descent.
  2. People with Peutz Jhegers syndrome associated with STK11 gene mutations should begin pancreas cancer screening at age 40 regardless of their family history.
  3. Familial Atypical Mole Melanoma (FAMMM) occurs in families with histories of melanoma. This is associated with mutations in the CDKN2A/p16 gene. Individuals with FAMMM and a mutation in CDKN2A who have at least one relative affected by pancreatic cancer should consider pancreas cancer screening.
  4. Individuals who have hereditary pancreatitis are at a higher risk for developing pancreatic cancer. Hereditary pancreatitis is associated with episodes of pancreatitis starting at an early age. The chronic inflammation caused by pancreatitis and mutations in the PRSS1 gene associated with hereditary pancreatitis are both risk factors that increase pancreatic cancer risk. Individuals with hereditary pancreatitis and known PRSS1 should be screened for pancreatic cancer starting at age 40.
  5. Hereditary nonpolyposis colorectal cancer syndrome (HNPCC) or Lynch syndrome is a genetic syndrome affecting mismatch repair genes that increases the risk for colon, endometrial, stomach, ovarian and pancreas cancers. Individuals with Lynch syndrome who have at least one family member affected by pancreatic cancer should be screened for pancreatic cancer.
  6. Ataxia-telangiectasia syndrome caused by mutations in ATM gene who have at least one should be screened for pancreatic cancer (ATM) mutation carriers who have at least one family member affected by pancreas cancer should consider screening

What kind of pancreas screening tests are available?

Pancreatic cancer early detection tests use a combination of medical imagining techniques that can pick up small lesions and cysts. Most commonly doctors recommend a combination of EUS, MRI and CT scans at regular intervals for people who are susceptible to pancreas cancer. The screening recommendations vary for each individual. At The Johns Hopkins Hospital you will meet with one of our physicians before beginning screening to discuss your risk and develop a plan appropriate to you. Our team of radiologists, gastroenterologists, endoscopists, surgeons, pathologists and genetic counselors work together to create screening plans and make recommendations to individuals and family members. Genetic testing and genetic counseling are an optional part of pancreatic screening that may help some individuals understand their risk factors.

EUS +
EUS is considered one of the most accurate tools for detection of small lesions that are not visible by CT scan. During an Endoscopic Ultrasound (EUS), is procedure a doctor passes an endoscope with an ultrasound probe attached to it through the patientÔÇÖs mouth and into the stomach where we are able to scan the pancreas. EUS also does not involve ionizing radiation, it produces images of the pancreas through the stomach using ultrasound waves bounce off internal organs.

Secretin, a synthetic version of a hormone that stimulates your pancreas to produce juice is sometimes used in EUS, both to evaluate the function of your pancreas and to collect pancreatic juice secretions that may have diagnostic or research purposes.
Fine needle aspirates can also be used in EUS to make certain diagnoses.
MRI +
Imaging that uses radiofrequency waves and strong magnetic fields to provide detailed pictures of internal organs.
Secretin, a synthetic version of a hormone that stimulates your pancreas to produce juice is sometimes used in MRI, both to evaluate the function of your pancreas and to collect pancreatic juice secretions that may have diagnostic or research purposes.
CT +
Computed Tomography (CT) uses a combination of x-rays and computer technology to produce horizontal images, often called slices, of the body. CT scans of the pancreas provide detailed images of the organ. You may want to ask your doctor about the amount of radiation used in a CT scan and the risks related to your particular situations.

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