This statement summarizes the U.S. Preventive Services Task Force (USPSTF) recommendations on screening for pancreatic cancer and the supporting scientific evidence and updates the 1996 recommendations contained in the Guide to Clinical Preventive Services, 2d ed. (1) In 1996, the USPSTF recommended against screening for pancreatic cancer (D recommendation). (1) Since then, the USPSTF criteria to rate the strength of the evidence have changed. (2) Therefore, this recommendation statement has been updated and revised based on the current USPSTF methodology and rating of the strength of the evidence. Explanations of the current ratings and of the strength of overall evidence are given in Tables 1 and 2, respectively.
The complete information on which this statement is based, including evidence tables and references, is available in the brief evidence update (3) on this topic on the USPSTF Web site (http://www.preventiveservices.ahrq.gov). The recommendation is also posted on the Web site of the National Guideline Clearinghouse (http://www.guideline.gov).
Summary of Recommendation
The USPSTF recommends against routine screening for pancreatic cancer in asymptomatic adults using abdominal palpation, ultrasonography, or serologic markers. D recommendation.
The USPSTF found no evidence that screening for pancreatic cancer is effective in reducing mortality. There is a potential for significant harm because of the low prevalence of pancreatic cancer, limited accuracy of available screening tests, invasive nature of diagnostic tests, and poor outcomes of treatment. As a result, the USPSTF concluded that the harms of screening for pancreatic cancer exceed any potential benefits.
Clinical Considerations
* Because of the poor prognosis of patients diagnosed with pancreatic cancer, there is an interest in primary prevention. The evidence for diet-based prevention of pancreatic cancer is limited and conflicting. Some experts recommend lifestyle changes that may help prevent pancreatic cancer (e.g., stopping the use of tobacco products, moderating alcohol intake, eating a balanced diet with sufficient fruit and vegetables).
* Persons with hereditary pancreatitis may have a higher lifetime risk for developing pancreatic cancer (4); however, the USPSTF did not review the effectiveness of screening these persons.
REFERENCES
(1.) U.S. Preventive Services Task Force. Guide to clinical preventive services: report of the U.S. Preventive Services Task Force. 2d ed. Baltimore: Williams & Wilkins, 1996.
(2.) Harris RP, Helfand M, Woolf SH, Lohr KN, Mulrow CD, Teutsch SM, et al. Current methods of the U.S. Preventive Services Task Force: a review of the process. Am J Prev Med 2001;20(3 suppl):21-35.
(3.) U.S. Preventive Services Task Force. Screening for pancreatic cancer: a brief evidence update for the U.S. Preventive Services Task Force. Agency for Healthcare Research and Quality, 2004. Accessed online June 13, 2005, at: http://ahrq.gov/clinic/uspstf/uspspanc.htm.
(4.) Lowenfels AB, Maisonneuve P, DiMagno EP, Elitsur Y, Gates LK Jr, Perrault J, et al. Hereditary pancreatitis and the risk of pancreatic cancer. J Natl Cancer Inst 1997;89:442-6.
Address correspondence to Ned Calonge, M.D., M.P.H., Chair, U.S. Preventive Services Task Force, c/o Program Director, USPSTF, Agency for Healthcare Research and Quality, 540 Gaither Rd., Rockville, MD 20850 (e-mail: uspstf@ahrq.gov).
The U.S. Preventive Services Task Force recommendations are independent of the U.S. government. They do not represent the views of the Agency for Healthcare Research and Quality, the U.S. Department of Health and Human Services, or the U.S. Public Health Service.
The series coordinator is Charles Carter, M.D., Atlanta Medical Center Family Practice Residency, Morrow, Ga.
COPYRIGHT 2005 American Academy of Family Physicians
COPYRIGHT 2005 Gale Group
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