A Community-Based Pancreatic Cancer Screening Study in High-Risk Individuals: Preliminary Efficacy and Safety Results.
This study indicates that community-based pancreatic cancer screening using MRI is feasible, with 58.7% of participants showing abnormal findings.
Where it sits
this study against the rest of the pancragen (kedw) corpusSummary and findings
The study measured the safety and efficacy of a community-based pancreatic cancer screening program using MRI in high-risk individuals. Seventy-five participants underwent baseline and annual MRIs over an average follow-up of 2.6 years. Abnormal pancreatic findings were detected in 58.7% of participants, with 6.7% undergoing further procedures.
Abstract
<h4>Introduction</h4>Pancreatic cancer (PC) screening recommendations have been based on studies performed solely at high-volume academic centers. To make PC screening more widely available, community-based efforts are essential. We implemented a prospective PC screening study in the community of Fairfield County, CT, and report our early safety and efficacy results.<h4>Methods</h4>Eligible individuals were enrolled into an investigator-initiated study and underwent a baseline and 3 annual magnetic resonance imagings/magnetic resonance cholangiopancreatographies (MRIs/MRCPs) with gadolinium, biannual blood donations for biobanking, and assessments for anxiety and depression. All MRIs were presented at a multidisciplinary board to determine whether further investigation was warranted.<h4>Results</h4>Seventy-five individuals have been enrolled and 201 MRIs performed over a 2.6-year average length of follow-up. Abnormal pancreatic findings (predominantly small cysts) were detected in 58.7% of the participants. Among these, 6.7% underwent endoscopic ultrasound, with 1 case complicated by postprocedural pancreatitis. One surgical resection was performed on a 4.7-cm intraductal papillary mucinous neoplasm with a focus on low-grade pancreatic intraepithelial neoplasia. One incidental finding of fibrosing mediastinitis was detected. Anxiety and depression scores decreased over the course of this study from 21.4% to 5.4% and 10.7% to 3.6%, respectively.<h4>Discussion</h4>This preliminary report supports the feasibility of performing MRI/magnetic resonance cholangiopancreatographies-based PC screening as part of a clinical trial in a community setting. A longer follow-up is needed to better assess safety and efficacy. To the best of our knowledge, this is the first report from a community-based PC screening effort ( clinicaltrials.gov ID: NCT03250078).
Background
This paper addresses the need for community-based pancreatic cancer screening, as existing recommendations are primarily based on high-volume academic centers. Previous studies have not adequately explored the feasibility of such screenings in community settings. This study aims to provide preliminary efficacy and safety results from a community-based screening initiative in Fairfield County, CT.
Methods
The study was a prospective screening trial involving 75 eligible individuals who underwent baseline and three annual MRIs/MRCPs with gadolinium. Participants also provided biannual blood donations and underwent assessments for anxiety and depression. The primary outcome was the detection of abnormal pancreatic findings, while secondary outcomes included the rates of further investigations and changes in anxiety and depression scores.
Results
The primary endpoint revealed that 58.7% of participants had abnormal pancreatic findings. A total of 201 MRIs were performed over an average follow-up of 2.6 years. Among those with abnormal findings, 6.7% underwent endoscopic ultrasound, with one case of postprocedural pancreatitis reported. Additionally, one surgical resection was performed on a 4.7-cm intraductal papillary mucinous neoplasm.
Interpretation
The findings suggest that community-based pancreatic cancer screening using MRI is feasible, though the clinical significance of the detected abnormalities remains uncertain. The effect size regarding the detection of abnormalities is notable, but the small percentage of participants undergoing further procedures raises questions about the clinical relevance. Limitations include a small sample size and the need for longer follow-up to better assess the safety and efficacy of the screening program.
Key findings
- 58.7% of participants had abnormal pancreatic findings.
- 6.7% of participants underwent endoscopic ultrasound.
- One case of postprocedural pancreatitis was reported.
- Anxiety scores decreased from 21.4% to 5.4%.
- Depression scores decreased from 10.7% to 3.6%.
- 201 MRIs were performed over a 2.6-year average follow-up.
Limitations
- small sample size of 75 participants
- average follow-up of only 2.6 years
- limited generalizability to broader populations
- no control group for comparison
- potential for selection bias in participant enrollment