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 119-9 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%-4.02%). 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 It pancreatic cancer is more likely to be detected by using this screening protocol than by using standard means of detection. (Gastrointest Enclose 2011;74:87-95.)