title: Estimation of the Survival Benefit Obtainable From Screening for the Early Detection of Pancreatic Cancer.
abstract: OBJECTIVE
  The chance to improve survival from pancreatic adenocarcinoma relies on early diagnosis through screening, but any screening program is subject to lead-time bias and no data are available in this regard. Aim of the present study was to evaluate the benefit obtainable from a screening program for early detection of pancreatic adenocarcinoma, considering screen-related biases.
  
  
  METHODS
  Monte Carlo simulation was performed using data from 1000 pancreatic cancer patients admitted in a tertiary referral hospital and from pertinent literature. Lead-time bias was assessed and subtracted from expected survival.
  
  
  RESULTS
  Mean expected life expectancy was 13.0 months. Assuming a 20%, 30%, or 50% stage III/IV reduction with screening, pancreatic resections would increase from 217 to 290 in front of a 20% stage III/IV reduction to 324 in front of a 30% reduction and to 385 in front of a 50% reduction. After lead-time adjustment, life expectancies were 14.0, 14.6, and 15.9 months, respectively. The number-needed-to-screen calculation suggests that screening can be harmful in a proportion of patients inversely dependent on the length of follow-up and a significant improvement of survival after diagnosis.
  
  
  CONCLUSIONS
  Pancreatic adenocarcinoma screening program would probably be successful in the presence of a considerable improvement of postdiagnostic survival; otherwise, it only increases surgical procedure amount.
authors.affiliation: From the Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cucchetti
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ercolani
authors.forename: Matteo
authors.initials: M
authors.lastname: Cescon
authors.forename: Giovanni
authors.initials: G
authors.lastname: Brandi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Taffurelli
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Maroni
authors.forename: Matteo
authors.initials: M
authors.lastname: Ravaioli
authors.forename: Raffaele
authors.initials: R
authors.lastname: Pezzilli
authors.forename: Antonio Daniele
authors.initials: AD
authors.lastname: Pinna
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000401:mortality; D000368:Aged; D000369:Aged, 80 and over; D055088:Early Detection of Cancer / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D009010:Monte Carlo Method; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000401:mortality; D016730:Program Development; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D013997:Time Factors