Updated guidance on surveillance of patients with an increased risk for familial pancreatic cancer from the International Cancer of the Pancreas Surveillance (CAPS) Consortium.
Key recommendations include the following:
Offer surveillance to:
- All patients with Peutz-Jeghers syndrome (carriers of LKB1/STK11 mutation)
- All carriers of CDKN2A mutation
- Carriers of BRCA2, BRCA1, PALB2, ATM, MLH1, MSH2 or MSH6 mutation, with ≥1 affected first-degree blood relative
- Individuals with ≥1 first-degree relative with pancreatic cancer who also have a first-degree relative with pancreatic cancer (familial pancreatic cancer kindred)
- Familial pancreatic cancer kindred (without known mutation): age 50 or 55 years or 10 years younger than the youngest affected blood relative (YABR)
- CDKN2A Peutz-Jegher syndrome: age 40 years
- BRCA2, ATM, PALB2, BRCA1, MLH1/MSH2: age 45 or 50 years or 10 years younger than YABR
Measure MRI/MRCP+EUS + fasting blood glucose and/or HbA1c at baseline.
During follow-up, routine fasting blood glucose and/or HbA1, and alternate MRI/MRCP and EUS.
Serum CA 19-9 if concerning features on imaging.
EUS-FNA only for:
- Solid lesions ≥5 mm
- Cystic lesions with worrisome features
- Asymptomatic main pancreatic duct (MPD) strictures (with/without mass)
CT only for:
- Solid lesions (any size)
- Asymptomatic MPD strictures of unknown aetiology (without mass)
- 12 months: no abnormalities or concerning abnormalities
- 3-6 months: if concerning abnormalities not indicated for immediate surgery