47 research outputs found
Surveillance of Individuals at High Risk for Developing Pancreatic Cancer
__Abstract__
We still face great difficulties to treat and cure patients with pancreatic ductal
adenocarcinoma (henceforth referred to as pancreatic cancer). The survival is dismal even
in those who undergo intended curative surgery in case of a localized tumor. Despite the
relatively low incidence of 9-12 per 100.000 per year in Western populations (approximate
lifetime-risk 1.0%), pancreatic cancer is ranked among the to
Evolution of features of chronic pancreatitis during endoscopic ultrasound-based surveillance of individuals at high risk for pancreatic cancer
Background and study aimsâDuring endoscopic ultrasound (EUS)-based pancreatic ductal adenocarcinoma (PDAC)-surveillance in asymptomatic individuals, features of chronic pancreatitis (CP) are often detected. Little is known about the prevalence and progression of these features. The aim of this study was to quantify these features, assess the interobserver agreement, assess possible associated factors, and assess the natural course during 3 years of follow-up.
Patients and methodsâTwo experienced endosonographers reviewed anonymized sequential EUS videos of participants in PDAC surveillance that were obtained in 2012 and 2015 for features of CP. Descriptives, agreement analyses, univariate and multivariate analyses for possible risk factors, and repeated measures analyses to assess intra-individual changes over time were performed.
ResultsâA total of 42 EUS videos of 21 participants were reviewed. Any feature of CP was present in 86â% (2012) and 81â% (2015) of participants, with a mean of 2.5 features per individual. The overall interobserver agreement was almost perfect at 83â%. No baseline factors were significantly associated with features of CP. Features did not change over time, except for hyperechoic foci without shadowing, which decreased intra-individually (ÎČâ=âââ1.6, Pâ=â0.005).
ConclusionsâThis blinded study shows features of CP to be highly prevalent in individuals at high risk of developing pancreatic cancer. No baseline factors were associated with presence of these features. CP features did not increase intra-individually over a 3-year period. Longer follow-up and pathological examination of pancreatic resection specimens will be essential to learn whether EUS detection and follow-up of these CP features bear clinical relevance
Identifying key factors for the effectiveness of pancreatic cancer screening:A model-based analysis
Pancreatic cancer (PC) survival is poor, as detection usually occurs late, when treatment options are limited. Screening of high-risk individuals may enable early detection and a more favorable prognosis. Knowledge gaps prohibit establishing the effectiveness of screening. We developed a Microsimulation Screening Analysis model to analyze the impact of relevant uncertainties on the effect of PC screening in high-risk individuals. The model simulates two base cases: one in which lesions always progress to PC and one in which indolent and faster progressive lesions coexist. For each base case, the effect of annual and 5-yearly screening with endoscopic ultrasonography/magnetic resonance imaging was evaluated. The impact of variance in PC risk, screening test characteristics and surgery-related mortality was evaluated using sensitivity analyses. Screening resulted in a reduction of PC mortality by at least 16% in all simulated scenarios. This reduction depended strongly on the natural disease course (annual screening: â57% for âProgressive-onlyâ vs â41% for âIndolent Includedâ). The number of screen and surveillance tests needed to prevent one cancer death was impacted most by PC risk. A 10% increase in test sensitivity reduced mortality by 1.9% at most. Test specificity is important for the number of surveillance tests. In conclusion, screening reduces PC mortality in all modeled scenarios. The natural disease course and PC risk strongly determines the effectiveness of screening. Test sensitivity seems of lesser influence than specificity. Future research should gain more insight in PC pathobiology to establish the true value of PC screening in high-risk individuals.</p
Genomic sequence of yellow fever virus from a Dutch traveller returning from the Gambia-Senegal region, the Netherlands, November 2018
International cancer of the pancreas screening (CAPS) consortium summit on the management of patients with increased risk for familial pancreatic cancer
Background Screening individuals at increased risk for
pancreatic cancer (PC) detects early, potentially curable,
pancreatic neoplasia.
Objective To develop consortium statements on
screening, surveillance and management of high-risk
individuals with an inherited predisposition to PC.
Methods A 49-expert multidisciplinary international
consortium met to discuss pancreatic screening and vote
on statements. Consensus was considered reached if
â„75% agreed or disagreed.
Results There was excellent agreement that, to be
successful, a screening programme should detect and
treat T1N0M0 margin-negative PC and high-grade
dysplastic precursor lesions (pancreatic intraepithelial
neoplasia and intraductal papillary mucinous neoplasm). It
was agreed that the following were candidates for
screening: first-degree relatives (FDRs) of patients with
PC from a familial PC kindred with at least two affected
FDRs; patients with PeutzâJeghers syndrome; and p16,
BRCA2 and hereditary non-polyposis colorectal cancer
(HNPCC) mutation carriers with â„1 affected FDR.
Consensus was not reached for the age to initiate
screening or stop surveillance. It was agreed that initial
screening should include endoscopic ultrasonography
(EUS) and/or MRI/magnetic resonance
cholangiopancreatography not CT or endoscopic
retrograde cholangiopancreatography. There was no
consensus on the need for EUS fine-needle aspiration to
evaluate cysts. There was disagreement on optimal
screening modalities and intervals for follow-up imaging.
When surgery is recommended it should be performed at
a high-volume centre. There was great disagreement as
to which screeni
Patient-reported burden of intensified surveillance and surgery in high-risk individuals under pancreatic cancer surveillance
In high-risk individuals participating in a pancreatic cancer surveillance program, worrisome features warrant for intensified surveillance or, occasionally, surgery. Our objectives were to determine the patient-reported burden of intensified surveillance and/or surgery, and to assess post-operative quality of life and opinion of surgery. Participants in our pancreatic cancer surveillance program completed questionnaires including the Cancer Worry Scale (CWS) and the Hospital Anxiety and Depression Scale (HADS). For individuals who underwent intensified surveillance, questionnaires before, during, and â„ 3Â weeks after were analyzed. In addition, subjects who underwent intensified surveillance in the past 3Â years or underwent surgery at any time, were invited for an interview, that included the Short-Form 12 (SF-12). A total of 31 high-risk individuals were studied. During the intensified surveillance period, median CWS scores were higher (14, IQR 7), as compared to before (12, IQR 9, P = 0.007) and after (11, IQR 7, P = 0.014), but eventually returned back to baseline (P = 0.823). Median HADS scores were low: 5 (IQR 6) for anxiety and 3 (IQR 5) for depression, and they were unaff
Factors associated with cancer worries in individuals participating in annual pancreatic cancer surveillance
It is important to adequately and timely identify individuals with cancer worries amongst participants in a pancreatic ductal adenocarcinoma (PDAC) surveillance program, because they could benefit from psychosocial support to decrease distress. Therefore, the aim of this study was to assess both psychosocial and clinical factors associated with cancer worries. High-risk individuals participating in PDAC-surveillance were invited to annually complete a cancer worry scale (CWS) questionnaire which was sent after counseling by the clinical geneticist (T0), after intake for participation in PDAC-surveillance (T1), and then annually after every MRI and endoscopic ultrasonography (EUS) (T2 and furth