The benefit of pancreatic cancer surveillance in carriers of germline BRCA1/2 pathogenic variants

Ido Laish*, Menachem Schechter, Alain Dancour, Sari Lieberman, Zohar Levi, Yael Goldberg, Inbal Kedar, Erez Hasnis, Elizabeth Half, Gili Reznick Levi, Lior Katz, Elez D. Vainer, Dor Genzel, Maya Aharoni, Rakefet Chen-Shtoyerman, Naim Abu-Freha, Maria Raitses-Gurevich, Talia Golan, Rinat Bernstein-Molho, Merav Ben YehoyadaNathan Gluck, Guy Rosner

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Surveillance of high-risk individuals for pancreatic ductal adenocarcinoma (PDAC) is recommended. This study aimed to determine the prevalence and outcomes of PDAC and its precursor lesions in BRCA1/2 pathogenic variants (PVs) carriers undergoing pancreatic surveillance. Methods: A retrospective multicenter cohort study of pancreatic surveillance outcomes in Israeli BRCA1/2 carriers preferably with a family history of PDAC. Results: A total of 180 asymptomatic carriers participated in the screening programs, including 57 (31.7%) with BRCA1 PVs, 121 (67.2%) with BRCA2 PVs, and 12 (6.6%) with PVs in BRCA1/2 and other genes, for a median follow-up period of 4 years. Ninety-one individuals (50.5%) fulfilled the International Cancer of the Pancreas Screening (CAPS) criteria for surveillance whereas 116 (64.4%) fulfilled the American College of Gastroenterology (ACG) criteria. There were four cases of adenocarcinoma and four cases of grade 1-neuroendocrine tumor (G1-NET). All were BRCA2 carriers, and two had no family history of PDAC. Three cancer patients were at resectable stages (IA, IIA, IIB) whereas one had a stage IIIB tumor. Of the G1-NET cases, one had surgery and the others were only followed. Success rate for detection of confined pancreatic carcinoma was thus 1.6% (three of 180) in the whole cohort, 1.6% (two of 116) among individuals who fulfilled ACG criteria and 2.2% (two of 91) in those fulfilling CAPS criteria for surveillance. Conclusions: Despite the low detection rate of PDAC and its' high-risk neoplastic precursor lesions among BRCA1/2 carriers undergoing pancreatic surveillance, 75% of cancer cases were detected at a resectable stage.

Original languageEnglish
Pages (from-to)256-266
Number of pages11
JournalCancer
Volume130
Issue number2
DOIs
StatePublished - 15 Jan 2024

Keywords

  • BRCA carrier
  • pancreatic cancer
  • surveillance

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