Screening for pancreatic cancer in a high-risk population with serum CA 19-9 and targeted EUS: a feasibility study.

Background: Earlier detection of pancreatic adenocarcinoma is needed.

Objective: To determine whether early pancreatic neoplasia can be detected in a high-risk population by using CA 19-9 followed by targeted EUS.

Design: Prospective cohort study.

Setting: Two academic medical centers.

Patients: Eligible patients met age criteria and had at least 1 first-degree relative with pancreatic adenocarcinoma.

Interventions: A serum CA 19-9 was performed on all patients. EUS was performed if the CA 19-9 level was elevated. FNA of identified lesions was performed. Patients with pancreatic cancer detected by using this screening protocol were compared with patients presenting off-protocol for staging data. Medicare reimbursement rates were used to derive cost data.

Main Outcome Measurements: Detection of early pancreatic neoplasia.

Results: A total of 546 patients were enrolled. CA 19-9 was elevated in 27 patients (4.9%, 95% CI, 3.2%-7.1%). Neoplastic or malignant findings were detected in 5 patients (0.9%, 95% CI, 0.3%-2.1%), and pancreatic adenocarcinoma in 1 patient (0.2%, 95% CI, 0.005%-1.02%). The patient with pancreatic cancer detected as part of this protocol was 1 of 2 patients presenting to the University of Vermont with stage 1 cancer. The cost to detect 1 pancreatic neoplasia was $8431. The cost to detect 1 pancreatic adenocarcinoma was $41,133.

Limitations: The sample size is adequate only to demonstrate the feasibility of this approach.

Conclusions: Potentially curative pancreatic adenocarcinoma can be identified with this screening protocol. Stage 1 pancreatic cancer is more likely to be detected by using this screening protocol than by using standard means of detection.