title: Screening for pancreatic cancer in familial high-risk individuals: A systematic review.
abstract: OBJECTIVE
  To analyze the benefits and harms of pancreatic cancer screening in familial high-risk individuals (HRIs).
  
  
  METHODS
  Studies were identified by searching PubMed, EBSCO, ClinicalTrials.gov and the Cochrane database from database inception to June 2014. We also obtained papers from the reference lists of pertinent studies and systematic reviews. English-language trials and observational studies were searched. The key words used as search terms were "screening" and "surveillance". Cost-effectiveness, diagnostic rate, survival rate, mortality and adverse events were the outcomes of interest. Age, sex, lifestyle and other confounding factors were also considered. However, anticipating only a few of these studies, we also included observational studies with or without control groups. We also included studies concerning the anxiety associated with pancreatic cancer risk and other psychological changes in familial HRIs. We extracted details on study design, objectives, population characteristics, inclusion criteria, year of enrollment, method of screening, adjusted and unadjusted mortality, cost-effectiveness and adverse events from the included studies. Studies were assessed using the Reporting of Observational studies in Epidemiology (STROBE) checklist.
  
  
  RESULTS
  Sixteen studies on pancreatic cancer screening were included. Five studies included control groups, nine were observational studies without control groups, and the other two studies investigated the worry associated with pancreatic cancer risk. We found that pancreatic cancer screening resulted in a high curative resection rate (60% vs 25%, P = 0.011), longer median survival time (14.5 mo vs 4 mo, P < 0.001), and higher 3-year survival rate (20% vs 15.0%, P = 0.624). We also found that familial HRIs had a higher diagnostic rate of pancreatic tumors than controls (34% vs 7.2%, P < 0.001). In patients who underwent regular physical examinations, more stage I pancreatic cancers were observed (19% vs 2.6%, P = 0.001). In addition, endoscopic ultrasonography, which was the main means of detection, diagnosed 64.3% of pancreatic cancers. In comparison, endoscopic retrograde cannulation of the pancreas, magnetic resonance imaging, and computed tomography diagnosed 28.6%, 42.9%, and 21.4%, respectively. For mass lesions, instant surgery was recommended because of the beneficial effects of post-operative chemotherapy. However, in patients with intraductal papillary mucinous neoplasms, we did not find a significant difference in outcome between surgery and follow-up without treatment. Moreover, pancreatic cancer screening in familial HRIs had a greater perceived risk of pancreatic cancer (P < 0.0001), higher levels of anxiety regarding pancreatic cancer (P < 0.0001), and increased economic burden.
  
  
  CONCLUSIONS
  Pancreatic cancer screening in familial HRIs is associated with a higher detection rate and longer survival, although screening may influence psychological function and increase the economic burden.
authors.affiliation: Chao Lu, Cheng-Fu Xu, Xing-Yong Wan, Hua-Tuo Zhu, Chao-Hui Yu, You-Ming Li, Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China.
authors.forename: Chao
authors.initials: C
authors.lastname: Lu
authors.affiliation: Chao Lu, Cheng-Fu Xu, Xing-Yong Wan, Hua-Tuo Zhu, Chao-Hui Yu, You-Ming Li, Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China.
authors.forename: Cheng-Fu
authors.initials: CF
authors.lastname: Xu
authors.affiliation: Chao Lu, Cheng-Fu Xu, Xing-Yong Wan, Hua-Tuo Zhu, Chao-Hui Yu, You-Ming Li, Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China.
authors.forename: Xing-Yong
authors.initials: XY
authors.lastname: Wan
authors.affiliation: Chao Lu, Cheng-Fu Xu, Xing-Yong Wan, Hua-Tuo Zhu, Chao-Hui Yu, You-Ming Li, Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China.
authors.forename: Hua-Tuo
authors.initials: HT
authors.lastname: Zhu
authors.affiliation: Chao Lu, Cheng-Fu Xu, Xing-Yong Wan, Hua-Tuo Zhu, Chao-Hui Yu, You-Ming Li, Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China.
authors.forename: Chao-Hui
authors.initials: CH
authors.lastname: Yu
authors.affiliation: Chao Lu, Cheng-Fu Xu, Xing-Yong Wan, Hua-Tuo Zhu, Chao-Hui Yu, You-Ming Li, Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China.
authors.forename: You-Ming
authors.initials: YM
authors.lastname: Li
mesh_terms: D014408:Biomarkers, Tumor / Q000235:genetics; D003952:Diagnostic Imaging / Q000379:methods; D055088:Early Detection of Cancer / Q000009:adverse effects / Q000379:methods* / Q000523:psychology; D020022:Genetic Predisposition to Disease; D005820:Genetic Testing; D040941:Heredity; D006801:Humans; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000401:mortality / Q000473:pathology / Q000523:psychology / Q000601:surgery; D010375:Pedigree; D010641:Phenotype; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor
keywords: Benefit; Familial high-risk individuals; Pancreatic cancer; Pancreatic tumor; Screening