ICARE Newsletter Fall 2022 

 Ask the Expert 

The below question was addressed by Dr. Kamran Idrees, Chief of the Division of Surgical Oncology & Endocrine Surgery, Associate Professor of Surgery, Ingram Associate Professor of Cancer Research, and Director of Pancreatic and Gastro Intestinal Surgical Oncology at Vanderbilt-Ingram Cancer Center. Dr. Idrees’ research has focused on colorectal cancer, liver metastases, and pancreatic cancer treatments. Dr. Indrees also leads the Vanderbilt Pancreas Center, which performs high-risk pancreatic cancer surveillance. Learn more at https://www.vanderbilthealth.com/service/high-risk-pancreatic-cancer-surveillance. If you have a question you would like addressed, please email the ICARE team at ICARE@vumc.org for consideration in future newsletters.

Q: I am 58 years old and have a BRCA2 mutation – should I get pancreatic cancer screening?
Per national and international practice guidelines,1,2 you are eligible for screening if you have at least one close relative (defined as a first- or second-degree relative, meaning parents, siblings, children, aunts, uncles, etc.) from the same side of the family the mutation is thought to be coming from. Screening is done each year starting at age 50 through MRI/MRCP alternating with endoscopic ultrasound. Recently, a new study evaluated pancreatic cancer screening in high-risk individuals defined based on family history and/or inherited gene mutation (BRCA1, BRCA2, CDKN2A, Lynch Syndrome genes, PALB2, ATM, and STK11).3 Findings showed that screening led to diagnosis at an earlier stage and improved survival. Specifically, in the entire sample of 1,731 high-risk patients, 26 pancreatic cancers were diagnosed. Of
these, there were 10 in the surveillance group, of whom the majority (57.9%) had stage 1 disease and 5.2% had stage IV disease. In contrast, of the 7 in the group outside of surveillance, the majority (85.7%) had stage IV disease. Survival of patients in the screen-detected group was 73.3% at 5 years, with a median overall survival of 9.8 years compared to 1.5 years in those diagnosed outside of surveillance (hazard ratio 0.13; 95% CI, 0.03–0.50; P = .003). These findings highlight the potential value of screening in those at high risk of pancreatic cancer, through MRI/MRCP and endoscopic ultrasound. When thinking about where to go for screening, it is important to go to a center with experience in these specialized tests. To that end, at Vanderbilt University Medical Center, we have recently expanded our high-risk pancreatic cancer clinic to follow those with inherited cancers through the nationally recommended screening modalities. If you or a family member think you may be at risk, please call the nurse navigator at (615) 473-1930 to schedule an appointment.

1NCCN Genetic/Familial Risk Assessment: Breast, Ovarian and Pancreatic. V1.2023. Available at: https://www.nccn.org/professionals/physician_gls/pdf/genetics_bop.pdf;
2Goggins et al. Gut. 2020;69(1):7-17. PMID: 31672839. Social media post February 4th, 2020. Available at:
3Dbouk et al. J Clin Oncol. 2022:JCO2200298. PMID: 35704792. Social media post July 26th, 2022. Available at: https://tinyurl.com/post7262022

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