title: International Cancer of the Pancreas Screening (CAPS) Consortium summit on the management of patients with increased risk for familial pancreatic cancer.
abstract: BACKGROUND
  Screening individuals at increased risk for pancreatic cancer (PC) detects early, potentially curable, pancreatic neoplasia.
  
  
  OBJECTIVE
  To develop consortium statements on screening, surveillance and management of high-risk individuals with an inherited predisposition to PC.
  
  
  METHODS
  A 49-expert multidisciplinary international consortium met to discuss pancreatic screening and vote on statements. Consensus was considered reached if ≥ 75% agreed or disagreed.
  
  
  RESULTS
  There was excellent agreement that, to be successful, a screening programme should detect and treat T1N0M0 margin-negative PC and high-grade dysplastic precursor lesions (pancreatic intraepithelial neoplasia and intraductal papillary mucinous neoplasm). It was agreed that the following were candidates for screening: first-degree relatives (FDRs) of patients with PC from a familial PC kindred with at least two affected FDRs; patients with Peutz-Jeghers syndrome; and p16, BRCA2 and hereditary non-polyposis colorectal cancer (HNPCC) mutation carriers with ≥ 1 affected FDR. Consensus was not reached for the age to initiate screening or stop surveillance. It was agreed that initial screening should include endoscopic ultrasonography (EUS) and/or MRI/magnetic resonance cholangiopancreatography not CT or endoscopic retrograde cholangiopancreatography. There was no consensus on the need for EUS fine-needle aspiration to evaluate cysts. There was disagreement on optimal screening modalities and intervals for follow-up imaging. When surgery is recommended it should be performed at a high-volume centre. There was great disagreement as to which screening abnormalities were of sufficient concern to for surgery to be recommended.
  
  
  CONCLUSIONS
  Screening is recommended for high-risk individuals, but more evidence is needed, particularly for how to manage patients with detected lesions. Screening and subsequent management should take place at high-volume centres with multidisciplinary teams, preferably within research protocols.
authors.affiliation: Division of Gastroenterology, Johns Hopkins University, The Sol Goldman Pancreatic Cancer Research Center, 1830 E Monument Street, Baltimore, MD 21205, USA. mcanto@jhmi.edu
authors.forename: Marcia Irene
authors.initials: MI
authors.lastname: Canto
authors.forename: Femme
authors.initials: F
authors.lastname: Harinck
authors.forename: Ralph H
authors.initials: RH
authors.lastname: Hruban
authors.forename: George Johan
authors.initials: GJ
authors.lastname: Offerhaus
authors.forename: Jan-Werner
authors.initials: JW
authors.lastname: Poley
authors.forename: Ihab
authors.initials: I
authors.lastname: Kamel
authors.forename: Yung
authors.initials: Y
authors.lastname: Nio
authors.forename: Richard S
authors.initials: RS
authors.lastname: Schulick
authors.forename: Claudio
authors.initials: C
authors.lastname: Bassi
authors.forename: Irma
authors.initials: I
authors.lastname: Kluijt
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Levy
authors.forename: Amitabh
authors.initials: A
authors.lastname: Chak
authors.forename: Paul
authors.initials: P
authors.lastname: Fockens
authors.forename: Michael
authors.initials: M
authors.lastname: Goggins
authors.forename: Marco
authors.initials: M
authors.lastname: Bruno
mesh_terms: D000367:Age Factors; D002277:Carcinoma / Q000175:diagnosis* / Q000235:genetics / Q000601:surgery; D049448:Cholangiopancreatography, Magnetic Resonance; D055088:Early Detection of Cancer; D019160:Endosonography; D005500:Follow-Up Studies; D020022:Genetic Predisposition to Disease; D006801:Humans; D009154:Mutation / Q000235:genetics; D060787:Neoplasm Grading; D010180:Pancreatectomy / Q000592:standards*; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000601:surgery; D010375:Pedigree; D012307:Risk Factors; D016896:Treatment Outcome