Targeted screening of individuals at high risk for pancreatic cancer: results of a simulation model.
OBJECTIVE
To identify when, from the standpoint of relative risk, magnetic resonance (MR) imaging-based screening may be effective in patients with a known or suspected genetic predisposition to pancreatic cancer.


METHODS
The authors developed a Markov model of pancreatic ductal adenocarcinoma (PDAC). The model was calibrated to National Cancer Institute Surveillance, Epidemiology, and End Results registry data and informed by the literature. A hypothetical screening strategy was evaluated in which all population individuals underwent one-time MR imaging screening at age 50 years. Screening outcomes for individuals with an average risk for PDAC ("base case") were compared with those for individuals at an increased risk to assess for differential benefits in populations with a known or suspected genetic predisposition. Effects of varying key inputs, including MR imaging performance, surgical mortality, and screening age, were evaluated with a sensitivity analysis. RESULTS In the base case, screening resulted in a small number of cancer deaths averted (39 of 100 000 men, 38 of 100 000 women) and a net decrease in life expectancy (-3 days for men, -4 days for women), which was driven by unnecessary pancreatic surgeries associated with false-positive results. Life expectancy gains were achieved if an individual's risk for PDAC exceeded 2.4 (men) or 2.7 (women) times that of the general population. When relative risk increased further, for example to 30 times that of the general population, averted cancer deaths and life expectancy gains increased substantially (1219 of 100 000 men, life expectancy gain: 65 days; 1204 of 100 000 women, life expectancy gain: 71 days). In addition, results were sensitive to MR imaging specificity and the surgical mortality rate.


CONCLUSIONS
Although PDAC screening with MR imaging for the entire population is not effective, individuals with even modestly increased risk may benefit.
From the Massachusetts General Hospital Institute for Technology Assessment (P.V.P., C.H., E.C.D., C.Y.K., A.T., K.E.P., C.H.), Department of Radiology (P.V.P., C.H., E.C.D., C.Y.K., A.T.), and Department of General Medicine, Gastrointestinal Unit (K.E.P., W.B., C.H.), Massachusetts General Hospital, 101 Merrimac St, 10th Floor, Boston, MA 02114; and Harvard Medical School, Boston, Mass.
Pari V
PV
Pandharipande
Curtis
C
Heberle
Emily C
EC
Dowling
Chung Yin
CY
Kong
Angela
A
Tramontano
Katherine E
KE
Perzan
William
W
Brugge
Chin
C
Hur
D002138:Calibration; D049448:Cholangiopancreatography, Magnetic Resonance; D003198:Computer Simulation; D018450:Disease Progression; D005260:Female; D006801:Humans; D008017:Life Expectancy; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008390:Markov Chains; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D015995:Prevalence; D012306:Risk; D012680:Sensitivity and Specificity