New ASGE Guidelines on Pancreatic Cancer Screening

All patients with pancreatic cancer are recommended to undergo genetic testing to eliminate any mutations that predispose them to cancer, according to the American Society for Gastrointestinal Endoscopy’s (ASGE) new set of guidelines on pancreatic cancer.

“If we find such mutations, then we can ‘cascade test’ their family members,” explained Mandeep S Sawhney, MD, MS, FASGE, who is the co-principal investigator of the guideline. “For any family member who’s found to have that same mutation, that can be a huge benefit because now they can avail themselves of screening.”

The new evidence-based recommendations focus mainly on pancreatic cancer screening for patients who have the BRCA1 and BRCA2 pathogenic variants.

Previous guidelines suggested that we should consider pancreatic cancer screening only in those with BRCA1/2 pathogenic variants who also have a family history of pancreatic cancer. “One study found that almost two-thirds of pancreatic cancers that develop in BRCA1/2 individuals would be missed if we limited screening to only those with a family history of pancreatic cancer. Therefore, a major change in these guidelines is that now we’re suggesting that all individuals with BRCA1/2, regardless of family history, should undergo pancreatic cancer screening,” said Dr Sawhney.

The new guidelines still recommend annual screening with EUS, MRI, or a combination of these modalities. The age to start screening should depend on the genetic condition, according to the new summary.

—Priyam Vora

Reference:
Sawhney MS, Calderwood AH, Thosani NC, Vollmer CM, and Qumseya BJ. ASGE guideline on screening for pancreatic cancer in individuals with genetic susceptibility: Summary and recommendations. Gastrointestinal Endoscopy. 2022; 95: 5(817-826). Doi: https://doi.org/10.1016/j.gie.2021.12.001