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The 2022 report from eight US centres: among 1,461 people at high inherited risk under regular scanning, most pancreatic cancers were caught at stage I, and across all the CAPS cohorts patients whose cancer was found by surveillance lived a median of nearly ten years against a year and a half for those found outside it.
Dbouk, Goggins and colleagues report the CAPS5 study, 1,461 high-risk individuals enrolled at eight centres between 2014 and 2021, 48.5 percent with a pathogenic variant in a susceptibility gene. Ten were diagnosed with pancreatic cancer, one metastatic four years after leaving surveillance; of the other nine, seven (77.8 percent) were stage I by surgical pathology, one stage II and one stage III, and seven of nine were alive at a median of 2.6 years. Eight more had surgery for worrisome lesions (three high-grade, five low-grade dysplasia). Across CAPS1 to CAPS5 (1,731 patients), 26 cancers were diagnosed, 19 within surveillance, 57.9 percent stage I and 5.2 percent stage IV, against six of seven (85.7 percent) stage IV among cancers found outside surveillance. Five-year survival of screen-detected cancer was 73.3 percent and median overall survival 9.8 years, against 1.5 years outside surveillance (hazard ratio 0.13, 95 percent confidence interval 0.03 to 0.50, P = 0.003).
The stage shift the pancreatic cancer page quotes (about three in four surveillance-detected cancers at stage I) and the strongest argument for offering surveillance to every germline carrier found by universal testing, which the NHS does not yet do outside research.
The rulebook behind the CAPS cohorts and the UK EUROPAC programme; it is also the reason surveillance for carriers is not yet a routine NHS service, because the consortium itself asked for it to stay within research until benefit was shown.
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.
Shares High-risk pancreatic surveillance (CAPS / PRECEDE), MRI, The hardest cancers are found late, Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question and the tag pancreatic-evidence.
Shares Hazard ratio (HR), Overall survival (OS), Resectable pancreatic ductal adenocarcinoma, Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question and the tag pancreatic-evidence.
Shares MRI, The hardest cancers are found late, Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question, Pancreatic ductal adenocarcinoma and the tag pancreatic-evidence.
Shares The hardest cancers are found late, Germline (hereditary) testing, Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question, Pancreatic ductal adenocarcinoma and the tag pancreatic-evidence.
Shares Resectable pancreatic ductal adenocarcinoma, Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question, Journal of Clinical Oncology, Pancreatic ductal adenocarcinoma and the tag pancreatic-evidence.
Shares Overall survival (OS), Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question, Journal of Clinical Oncology, Pancreatic ductal adenocarcinoma and the tag pancreatic-evidence.
Shares Hazard ratio (HR), Overall survival (OS), Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question, Pancreatic ductal adenocarcinoma and the tag pancreatic-evidence.
Shares The hardest cancers are found late, Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question, Pancreatic ductal adenocarcinoma and the tag pancreatic-evidence.