The Debate Over Early Screening for Pancreatic Cancer Continues

Tony Hagen @oncobiz
Published: Thursday, Mar 07, 2019
Higher costs associated with advanced stage pancreatic cancer, are potentially avoidable with screening and earlier treatment. A number of studies have addressed this; however, the US Preventive Services Task Force (USPSTF) in an ongoing draft review has reaffirmed its stance against screening in asymptomatic individuals.

The diagnostic yield for highrisk pancreatic lesions regardless of the form of screening was found to be 0.74 (95% CI, 0.33-1.14). The number of patients who had to be screened to identify 1 patient with a high-risk lesion was 135. The study also found that between 253 and 281 patients would need to be screened to prevent 1 death from pancreatic cancer. That estimate was lower than for hemoccult in stool (n = 880) or mammography (n = 1887) in the general population but similar to low-dose computed tomography for lung cancer in smokers (n = 320) and higher than colonoscopy in high-risk individuals (n <40). The authors concluded that further studies are needed to determine whether screening lowers mortality and is cost-effective for patients at high risk for pancreatic cancer.

Table. Costs of Pancreatic Cancer Screening Per Year of Life Added (2015 Values)6

Table. Costs of Pancreatic Cancer Screening Per Year of Life Added (2015 Values)6 A study by Ghatnekar et al noted the high percentage of inoperable patients with late-stage PC (80%-85%) in discussing the desirability of earlier diagnosis. The group developed a framework for modeling cost and health effects from early detection of pancreatic cancer that allowed them to analyze its cost-effectiveness. They estimated costs and quality- adjusted life-years (QALYs) arising from screening for pancreatic cancer and compared those metrics with results of a wait-and-see approach. Patients at high risk for ductal pancreatic cancer were screened with an affinity proteomic test based on a serum biomarker signature. Investigators found that the incremental cost per QALY gained was ,543 in 2013 US dollars (,919 in current US dollars), which the authors explained was cost-effective in Europe, where the 6-year-old study was done.2


References

  1. Corral JE, Mareth KF, Riegert-Johnson DL, Das A, Wallace MB. Diagnostic yield from screening asymptomatic individuals at high risk for pancreatic cancer: a meta-analysis of cohort studies. Clin Gastroenterol Hepatol. 2019;17(1):41-53. doi: 10.1016/j.cgh.2018.04.065.
  2. Ghatnekar O, Andersson R, Svensson M, et al. Modelling the benefits of early diagnosis of pancreatic cancer using a biomarker signature. Int J Cancer. 2013;133(10):2392-2397. doi: 10.1002/ijc.28256.
  3. Rulyak SJ, Kimmey MB, Veenstra DL, Brentnall TA. Cost-effectiveness of pancreatic cancer screening in familial pancreatic cancer kindreds. Gastrointest Endosc. 2003;57(1):23-29. doi: 10.1067/mge.2003.28.
  4. Pancreatic cancer: screening. US Preventive Services Task Force website. uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/pancreatic-cancer-screening. Published February 2004. Accessed February 12, 2019.
  5. Final research plan for pancreatic cancer: screening. US Preventive Services Task Force website. uspreventiveservicestaskforce.org/Page/Document/final-research-plan/pancreatic-cancer-screening1. Updated August 2017. Accessed February 12, 2019.
  6. Bruenderman E, Martin RCG II. A cost analysis of a pancreatic cancer screening protocol in high-risk populations. Am J Surg. 2015;210(3):409-416. doi: 10.1016/j.amjsurg.2014.11.017.

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