title: Screening for pancreatic cancer in a high-risk population with serum CA 19-9 and targeted EUS: a feasibility study.
abstract: 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.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Two academic medical centers.
  
  
  METHODS
  Eligible patients met age criteria and had at least 1 first-degree relative with pancreatic adenocarcinoma.
  
  
  METHODS
  A serum CA 19-9 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.
  
  
  METHODS
  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%-1.02%). 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.
  
  
  CONCLUSIONS
  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 1 pancreatic cancer is more likely to be detected by using this screening protocol than by using standard means of detection.
authors.affiliation: Division of Gastroenterology, University of Vermont, Burlington, VT, USA. Richard.Zubarik@vtmednet.org
authors.forename: Richard
authors.initials: R
authors.lastname: Zubarik
authors.forename: Stuart R
authors.initials: SR
authors.lastname: Gordon
authors.forename: Steven D
authors.initials: SD
authors.lastname: Lidofsky
authors.forename: Scott R
authors.initials: SR
authors.lastname: Anderson
authors.forename: J Marc
authors.initials: JM
authors.lastname: Pipas
authors.forename: Gary
authors.initials: G
authors.lastname: Badger
authors.forename: Eric
authors.initials: E
authors.lastname: Ganguly
authors.forename: James
authors.initials: J
authors.lastname: Vecchio
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D014408:Biomarkers, Tumor / Q000097:blood*; D018395:CA-19-9 Antigen / Q000097:blood*; D055088:Early Detection of Cancer; D019160:Endosonography; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D011446:Prospective Studies
chemical_list: D014408:Biomarkers, Tumor; D018395:CA-19-9 Antigen