Some support for pancreatic cancer screening

For people at high genetic risk of pancreas cancer, screening for the disease might be worthwhile - particularly if they're senior citizens, a new study suggests.

On the other hand, the researchers say, it might not be worthwhile - and it's too soon to make widespread recommendations on screening high-risk families.

Only about 3 of every 100 patients with pancreatic cancer have the "familial form."

But the findings in this group offer reason to be "cautiously hopeful" that there might be ways to detect the often-fatal cancer earlier, said lead researcher Dr. Emmy Ludwig, of Memorial Sloan-Kettering Cancer Center in New York.

The study, reported in the American Journal of Gastroenterology, focused on families affected by familial pancreatic cancer - where the disease has affected two or more first-degree relatives. First-degree relatives are either parents and children, or siblings.

Pancreatic cancer, whether due to an inherited gene or not, has a dim prognosis. Only about five of every hundred patients are still alive 5 years after diagnosis. That's largely because it is rarely caught early. The symptoms include weight loss and liver problems that cause the skin to turn yellow, but those usually don't show up until the cancer has spread.

It would seem to make sense to screen people from families affected by familial pancreatic cancer, but there are still many questions. For example, researchers are not sure which tests can reliably detect pancreatic cancer in people without symptoms, which people from affected families should be screened, or at what age screening should start.

For the new study, Ludwig and her colleagues offered screening to 309 relatives of people with familial pancreatic cancer. Some had at least one first-degree relative who developed pancreatic cancer before age 50. Others had family members who developed pancreatic cancer at any age - not just a parent, child or sibling but also a grandparent, grandchild, aunt or uncle, or a sibling's child.

Some participants had gene mutations linked to hereditary pancreatic cancer, plus a family history of the disease.

Over 7 years, 109 people in the study underwent screening at least once with MRI scans of the pancreas. If the MRI showed something suspicious-looking, they could have further testing with endoscopic ultrasound, where an ultrasound probe is threaded down the throat and into the small intestine, where it is then aimed at the pancreas.

Overall, MRI scans caught potential problems in 18 study participants. Nine - or 8 percent of the whole group - had abnormalities that could become cancer. Six later had surgery to remove these lesions, while the rest refused surgery and decided to keep up with screening.

Six of the nine patients with abnormal lesions were older than 65. Perhaps, the researchers say, this means screening after age 65 could prove most useful - but that requires further study.