{"entity":{"id":"paper-canto-caps-long-term-surveillance-gastroenterology-2018","kind":"paper","name":"Risk of Neoplastic Progression in Individuals at High Risk for Pancreatic Cancer Undergoing Long-term Surveillance","aka":[],"tldr":"The 2018 Johns Hopkins report of 354 people with inherited or family risk scanned for up to 16 years: 7 percent progressed to cancer or a high-grade precursor, 9 of the 10 cancers found by the scans were operable, and 85 percent of those patients were alive at three years.","summary":"Canto and colleagues analysed 354 high-risk individuals enrolled in the Cancer of the Pancreas Screening cohorts at tertiary academic centres from 1998 to 2014 (median follow-up 5.6 years), evaluated at baseline by endoscopic ultrasound and followed with endoscopic ultrasound, MRI and/or CT. Lesions with worrisome features (solid mass, multiple cysts, cyst over 3 cm, thickened walls, mural nodule, main duct over 5 mm, abrupt duct change) or rapid cyst growth were found in 68 patients (19 percent). Twenty-four (7 percent) had neoplastic progression (14 cancers, 10 high-grade dysplasia) over 16 years, 1.6 percent per year; 93 percent had detectable worrisome features beforehand. Nine of 10 cancers found during routine surveillance were resectable, and 85 percent of those patients survived three years against 25 percent of the four with symptomatic unresectable cancers that arose outside surveillance (P less than 0.0001). Median age at progression was 67 and median time from baseline to cancer 4.8 years.","asOf":"2026-09-24","links":[{"label":"Gastroenterology 2018","url":"https://doi.org/10.1053/j.gastro.2018.05.035"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/29803839/"}],"tags":["pancreatic-evidence"],"related":["paper-caps-consortium-surveillance-recommendations-gut-2020","paper-dbouk-caps5-stage-survival-jco-2022"],"cancers":["pancreatic","ipmn-cystic-precursors","resectable-pdac"],"sections":[],"technologies":["pancreatic-surveillance","mri","ct"],"targets":[],"drugs":[],"companies":[],"institutions":["johns-hopkins"],"pathways":[],"terms":[],"trials":["precede"],"people":[],"bottlenecks":["b-hereditary-risk","b-early-detection"],"keyPapers":[],"journals":["gastroenterology"],"dependsOn":[],"notes":[],"journal":"Gastroenterology","year":2018,"doi":"10.1053/j.gastro.2018.05.035","pmid":"29803839","authors":"Canto MI, Almario JA, Schulick RD, et al.","paperType":"observational","findings":["354 high-risk individuals, 16 years; 7 percent progressed (14 cancers, 10 high-grade dysplasia), 1.6 percent per year.","9 of 10 surveillance-detected cancers resectable; three-year survival 85 versus 25 percent for cancers arising outside surveillance.","Median time from baseline to cancer 4.8 years."],"whatItMeans":"The first long-term evidence that surveillance in high-risk people finds operable cancers, and the source of the imaging features that trigger surgery in the CAPS recommendations.","caveats":["Single-programme, expert-centre cohort; lead-time and length-time bias inflate survival comparisons.","Four unresectable cancers is a small comparison group."],"participants":354},"route":"/key-papers/paper-canto-caps-long-term-surveillance-gastroenterology-2018/","neighbours":{"paper":[{"id":"paper-caps-consortium-surveillance-recommendations-gut-2020","kind":"paper","name":"Management of patients with increased risk for familial pancreatic cancer: updated recommendations from the International Cancer of the Pancreas Screening (CAPS) Consortium","route":"/key-papers/paper-caps-consortium-surveillance-recommendations-gut-2020/"},{"id":"paper-dbouk-caps5-stage-survival-jco-2022","kind":"paper","name":"The Multicenter Cancer of Pancreas Screening Study: Impact on Stage and Survival","route":"/key-papers/paper-dbouk-caps5-stage-survival-jco-2022/"}],"cancer":[{"id":"ipmn-cystic-precursors","kind":"cancer","name":"Intraductal papillary mucinous neoplasm and other pancreatic cystic precursors","route":"/cancers/ipmn-cystic-precursors/"},{"id":"pancreatic","kind":"cancer","name":"Pancreatic ductal adenocarcinoma","route":"/cancers/pancreatic/"},{"id":"resectable-pdac","kind":"cancer","name":"Resectable pancreatic ductal adenocarcinoma","route":"/cancers/resectable-pdac/"}],"technology":[{"id":"ct","kind":"technology","name":"CT (computed tomography)","route":"/technologies/ct/"},{"id":"pancreatic-surveillance","kind":"technology","name":"High-risk pancreatic surveillance (CAPS / PRECEDE)","route":"/technologies/pancreatic-surveillance/"},{"id":"mri","kind":"technology","name":"MRI","route":"/technologies/mri/"}],"institution":[{"id":"johns-hopkins","kind":"institution","name":"Johns Hopkins Hospital / Sidney Kimmel Comprehensive Cancer Center","route":"/institutions/johns-hopkins/"}],"trial":[{"id":"precede","kind":"trial","name":"PRECEDE","route":"/trials/precede/"}],"bottleneck":[{"id":"b-hereditary-risk","kind":"bottleneck","name":"Inherited risk is mostly unidentified","route":"/bottlenecks/b-hereditary-risk/"},{"id":"b-early-detection","kind":"bottleneck","name":"The hardest cancers are found late","route":"/bottlenecks/b-early-detection/"}],"journal":[{"id":"gastroenterology","kind":"journal","name":"Gastroenterology","route":"/journals/gastroenterology/"}],"roadmap":[{"id":"pancreatic-roadmap","kind":"roadmap","name":"Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question","route":"/roadmaps/pancreatic-roadmap/"}],"idea":[{"id":"idea-pdac-surveillance-for-every-germline-carrier","kind":"idea","name":"Surveillance for every germline carrier found by universal testing, inside a registry rather than a research exception","route":"/ideas/idea-pdac-surveillance-for-every-germline-carrier/"}],"term":[{"id":"caps-consortium-pancreatic-screening","kind":"term","name":"CAPS: the Cancer of the Pancreas Screening consortium and its surveillance studies (CAPS1 to CAPS5)","route":"/terms/caps-consortium-pancreatic-screening/"}]}}