September 5, 2003
Alfred O. Berg, MD, MPH
Chair, USPSTF
C/o AHRQ
6010 Executive Blvd.
Suite 300
Rockville, MD 20852
Dear Dr. Berg:
The American College of Preventive Medicine (ACPM) is
pleased to provide comments on the draft Recommendation
Statement, "Screening for Pancreatic Cancer:
Recommendations and Rationale" developed by the
United States Preventive Services Task Force. ACPM
commends the Task Force for addressing this issue.
Please note that these comments are those of an
independent reviewer and do not reflect the official view
of ACPM nor of Dr. Feldman’s affiliations.
Thank you again for the opportunity to review the draft
statement. Please contact me if you have any questions. I
can be reached at
________________________________________________________________________
Review of the USPSTF draft Recommendation Statement on
Screening for Pancreatic Cancer: Recommendations and
Rationale.
BY: Gilbert, Omenn, MD, PhD
FOR: The American College of Preventive Medicine
DATE: September 5, 2003
Here are comments from me and my gastroenterologist
colleague, Michelle Anderson, MD, a clinical and
investigative expert on the pancreas:
The Task Force summaries and recommendations are highly
appropriate and evidence-based. They are accurate with
regard to the lack of quality information regarding
screening for pancreatic cancer in the average risk
person. The observation that no screening protocol has
been proved effective in any cohort at risk for pancreatic
cancer is true. Thus, we agree with the recommendation of
the Task Force against screening for pancreatic cancer in
asymptomatic, average-risk individuals.
However, we think there should be recognition of a
specific, not-rare subgroup. Persons with much higher than
average risk due to hereditary pancreatitis represent a
special population. In these individuals and families,
screening may be considered but probably still would not
be recommended. These individuals' risk of developing
pancreatic cancer is estimated to be 40% (cumulative) by
the age of 70 years (1). A consensus conference of
pancreatologists, scientists, surgeons, pathologists and
geneticists convened at the Third International Symposium
on Inherited Diseases of the Pancreas in Milan, Italy in
April, 2001. The recommendation of this consensus
conference was that screening should be offered to
hereditary pancreatitis patients beginning at age 40 years
(2). They recommended that screening be done at medical
centers with expertise in the care of patients with
hereditary pancreatitis and with state-of-the-art imaging
technology. It's important to note that the cost of
screening for pancreatic cancer even in this highly select
group is substantial. A recent modeling study which
examined the cost of surveillance in patients with HP
using EUS plus collection and storage of blood/serum and
pancreatic juice estimated a cost of $69, 600 per tumor
detected (3).
References:
1. Lowenfels AB, Maisonneuve P, DiMagno EP, et al.
Hereditary pancreatitis and the risk of pancreatic cancer.
International Hereditary pancreatitis Study Group. J Natl
Cancer Inst 1997;89:442-446.
2. Ulrich CD. Pancreatic cancer in hereditary pancreatitis:
Consensus guidelines for prevention, screening and
treatment. Pancreatology 2001; 1:416-422.
3. Martin SP, Ulrich CD. Pancreatic cancer surveillance in
a high risk cohort: Is it worth the cost? Med Clin North
Am 2000; 85:739-747.
