Abstract B18: Improving pancreatic cancer risk prediction through early detection
Authors: Snyder Courtney , Haag Susan G. , Adams Nickie , Hess Jade , Paskett Breann , Borazanci Erkut 
Published: May 2019

Introduction: It is estimated that by 2030 pancreatic cancer will be the second leading cause of cancer deaths in the US. Currently, only 9% of newly diagnosed pancreatic cancer is localized and 5-year survival is 7%. Due to most pancreatic cancers (PC) presenting at a later stage with poor overall survival, early detection methods must be implemented to improve treatment outcomes. Yet, effective early screening guidelines do not exist for pancreatic cancer. Our Early Detection Program (EDP) provides personalized early detection including risk assessment, screening, and genetic testing. We aim to evaluate risk assessment criteria, establish a database to delineate a pattern of characteristics, and utilize a biospecimen repository and molecular based technologies to map novel biomarkers for early detection.

Methods: This is a prospective study for individuals with a family history or a germline mutation consistent with risk for developing PC. Patients are eligible based on risk assessment criteria and stratified into 3 groups as defined by best available evidence based upon the CAPS Consortium and a prior prospective screening study. Patients are assessed at initial visit, have yearly screenings, and each case is discussed at a multi-disciplinary pancreatic tumor board. At the initial visit, patients undergo a thorough history and physical exam, genetic testing for germline mutations, routine blood tests along with Ca19-9 tumor marker and if indicated, MRI/MRCP abdomen, GI consult and EUS. Patients defined as average risk have one family member diagnosed with PC above the age of 55 years. Those at moderate risk are individuals with two or more first, second, third degree relatives with PC or one first degree relative with PC diagnosed &lt; 55 years. Those at high risk have three or more first, second, or third degree relatives with pancreatic cancer, two or more first degree relatives with pancreatic cancer, one first and one second degree relative with pancreatic cancer if one of the relatives was &lt; 55 years old at diagnosis, or have a genetic syndrome associated with pancreatic cancer. Study participants also complete a cancer anxiety index.

Results: Since the inception of the EDP (IRB approved November 2015), there have been no PC cases identified. Current participants include individuals age 34 to 79 with a mean age of 59. According to the current risk criteria 22% have a low PC risk, 26% have a moderate risk, and 52% have a high PC risk. All were advised a genetic assessment. Of the current sample, 36% were male and 64% were female, 55% used tobacco in the past, and 9% currently use tobacco. The BMI average is 26.85 (overweight), 2 participants have Type 2 diabetes, and several have had other types of cancer such as: 5% breast, 2% colon, 2% ovarian, 1% thyroid, and 38% had basal cell skin cancer. 26% had germline mutations and 10% with intraductal papillary mucinous neoplasm (IPMN).

Initial results reveal there is a level of anxiety associated with PC risk and some indicate their chance to develop cancer is high (M = 5.05, SD = 1.80). Compared to other people, participants stated their chance of getting cancer sometime in their life is a little higher (M = 4.10, SD = .85), and their ability to exercise control over their cancer risk was moderate (M = 2.6, SD .93).

Conclusions: Although the EDP is still recruiting patients, the effectiveness of our screening for PC has revealed some encouraging outcomes. Next-generation sequencing (NGS) and molecular based technologies will be explored for mapping novel biomarkers for early detection in a clinical study. The Institute is expanding to also include those at risk for breast and ovarian cancer. We will be evaluating risk assessment criteria and also current anxiety scales. A product of this study will be the development of a valid and reliable EDP index (EDP-I) anxiety instrument.

Citation Format: Courtney Snyder, Susan G. Haag, Nickie Adams, Jade Hess, Breann Paskett, Erkut Borazanci. Improving pancreatic cancer risk prediction through early detection. [abstract]. In: Proceedings of the AACR Special Conference: Improving Cancer Risk Prediction for Prevention and Early Detection; Nov 16-19, 2016; Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(5 Suppl):Abstract nr B18.