An international collaboration of scientists and healthcare professionals is developing a promising surveillance program for pancreatic cancer and driving new discoveries to improve early detection of the disease, when the chance of cure is highest.
Montreal, April 18, 2024-Global incidences of pancreatic cancer have risen dramatically in recent years, but the overall survival rate is currently only 12 per cent. When pancreatic tumours are detected early enough for treatment with surgical resection, the survival rate climbs to more than 80 per cent, but unfortunately, the vast majority of patients are diagnosed with advanced-stage disease.
This situation could improve, according to a study demonstrating the feasibility of a pancreatic cancer early detection and prevention project developed by the Pancreatic Cancer Early Detection Consortium (PRECEDE). In this study co-led by Dr. George Zogopoulos of the Research Institute of the McGill University Health Centre (RI-MUHC) and the Rosalind and Morris Goodman Cancer Institute at McGill University, the researchers developed an approach to improve surveillance of people at high risk of pancreatic cancer, tailored to different categories of individuals with specific risk factors. They also found that high-risk individuals with a family history of pancreatic cancer were at higher risk of having pancreatic cysts.
The researchers' work demonstrates that high-risk individuals adhere in high proportions to screening recommendations, and that the required screening imaging examinations are feasible in specialized health centres. It confirms PRECEDE's ability to implement this screening approach on an international scale and to collect research data with a view to refining knowledge in this field and increasing the effectiveness of clinical surveillance.
"Our work demonstrates the potential of a large international integrated clinical and research program developed to detect and intercept precancerous and cancerous changes in the pancreas. This surveillance program may lead to improved outcomes in a disease that currently has low survival rates," explains Dr. Zogopoulos, co-lead author of the study and scientist in the Cancer Research program at the RI-MUHC.
Based on their findings, published this week in JNCCN-Journal of the National Comprehensive Cancer Network, the investigators recommend sorting individuals at high risk for pancreatic cancer into three groups, based either on a family history of pancreatic cancer or the existence of a potentially cancer-causing genetic mutation (a pathogenic germline variant or PGV), or both.
"Individuals who are concerned they are at risk for pancreatic cancer can participate in PRECEDE and obtain an assessment from one the PRECEDE sites in North America and Europe. If the individual is assessed to be at increased risk for pancreatic cancer, they will have the opportunity to undergo clinical surveillance for pancreatic cancer, according to the clinical surveillance services available in their area," continues Dr. Zogopoulos.
Identifying and examining different risks factors
In the present study, the investigators examined longitudinal standardized clinical data-data that tracks the same type of information on the same subjects at multiple points in time-as well as imaging and biospecimen captures. Between April 1, 2020 and November 21, 2022, 3,402 individuals from more than 20 sites around the world were enrolled in one of seven study cohorts.
The highest-risk cohort (Cohort 1) included 1,759 participants (51.7%) for which annual imaging surveillance was recommended. Of note:
- Participants in Cohort 1 were all tested for mutations in genes commonly associated with pancreatic cancer and had pancreas imaging by MRI/MR cholangiopancreatography or endoscopic ultrasound.
- They were sorted into three subcategories: (1) individuals with familial history of pancreatic cancer (FPC), (2) individuals with a PGV and a FPC, (3) individuals with a PGV but without a FPC.
- Nearly 80 per cent of them (1,400 participants) had completed baseline imaging, i.e. all the required imaging exams at the time of enrollment.
An unexpected observation requiring further research
The researchers found a higher incidence of pancreatic cysts in people sorted into the high-risk sub-group based only on family history compared to those with a known genetic predisposition for pancreatic cancer but no family history of it. This suggests that familial pancreatic cancer follows different biological cancer development processes, compared to pancreatic cancer resulting from a hereditary mutation (PGV) in a known pancreatic cancer gene.
"The presence of cysts may identify individuals that are at increased risk of developing pancreatic cancer over time, because of cyst changes or because the presence of cysts signals that the pancreas has an intrinsic aberration making it more susceptible to cyst progression or other precancerous growths," says senior author Dr. Diane M. Simeone, UC San Diego Moores Cancer Center (New York University Langone Health at the time of the study). "Longer follow-up time is needed to determine if familial pancreatic cancer signifies a higher risk for developing pancreatic cancer compared to pathogenic germline variant status in a pancreatic-cancer-predisposition gene."
The newly published article is an interim analysis based on data obtained at the time participants enrolled in the study. The study continues at PRECEDE sites, including at the McGill University Health Centre, Abramson Cancer Center at the University of Pennsylvania, Dana-Farber Cancer Institute, Fred & Pamela Buffett Cancer Center, Fred Hutchinson Cancer Center, Huntsman Cancer Institute at the University of Utah, Mass General Cancer Center, Mayo Clinic Comprehensive Cancer Center, UC San Diego Moores Cancer Center, and Yale Cancer Center/Smilow Cancer Hospital. Over fifty medical centres around the world are now involved in the project.
About the study
"The Pancreatic Cancer Early Detection (PRECEDE) Study is a Global Effort to Drive Early Detection: Baseline Imaging Findings in High-Risk Individuals" by Zogopoulos G, Haimi I, Sanoba SA, et al. was published in JNCCN-Journal of the National Comprehensive Cancer Network
DOI: https://doi.org/10.6004/jnccn.2023.7097
About the Research Institute of the McGill University Health Centre
The Research Institute of the McGill University Health Centre (RI-MUHC) is a world-renowned biomedical and healthcare research centre. The Institute, which is affiliated with the Faculty of Medicine of McGill University, is the research arm of the McGill University Health Centre (MUHC) - an academic health centre located in Montreal, Canada, that has a mandate to focus on complex care within its community. The RI-MUHC supports over 600 researchers and close to 1,700 research trainees devoted to a broad spectrum of fundamental, clinical and health outcomes research at the Glen and the Montreal General Hospital sites of the MUHC. Its research facilities offer a dynamic multidisciplinary environment that fosters collaboration and leverages discovery aimed at improving the health of individual patients across their lifespan. The RI-MUHC is supported in part by the Fonds de recherche du Québec - Santé (FRQS). www.rimuhc.ca
