Screening for pancreatic cancer among smokers as high-risk individuals: Systematic review and meta-analysis of prospective cohort studies

• Published in: Health sciences review (Oxford, England) England), 2024-12, Vol.13, p.100203, Article 100203
• Main Authors: Elder, Melissa M., Vincent Mbous, Yves Paul, Rudisill, Toni Marie, Kelley, George A.
• Format: Article
• Language: English
• Subjects: Meta-analysis; Pancreatic cancer; Screening; Smokers
• ISSN: 2772-6320; 2772-6320
• DOI: 10.1016/j.hsr.2024.100203

•There are no formal screening guidelines for pancreatic cancer and often diagnosed late, with a high mortality rate.•This manuscript provides clinically relevant information for health care providers who manage this patient population.•This research is unique given its focus on asymptomatic versus hereditary diagnosis, using a robust search strategy.•This study is innovative for the following reasons: (1) use of the IVhet model over the less robust random-effects and fixed-effect(s) models that are used, (2) use of what is considered to be the more interpretable DOI plot versus the traditionally used funnel plot for small-study effects, (3) use of what is the more robust LFK index versus the traditionally used Egger's regression intercept test for the quantitative assessment of small-study, (4) use of 95 % prediction intervals, a statistic that is rarely used but a better measure of between-study heterogeneity than Q and I-squared. The main objective of this study was to conduct an aggregate data systematic review with meta-analysis of prospective cohort studies to determine the association between imaging screening for smoking and early diagnosis of pancreatic cancer (PC). Eligible studies included the following: 1) prospective cohort studies conducted in humans, 2) appropriate imaging screening method, 3) participants categorized into smoking as a high-risk group with no reported genetic disposition for PC, 4) no prior diagnosis of PC, 5) studies which detected and diagnosed adenocarcinoma following baseline screening, 6) data available for our primary outcome, PC, 7) studies published in the English language from January 1, 1992 to July 22, 2024. Any studies not meeting all of the above criteria were excluded. Information sources included the following: 1) PubMed, 2) CINAHL, 3) Scopus, 4) Cochrane Central Register of Controlled Trials (CENTRAL), 5) NIH National Cancer Institute's Division of Cancer Prevention, 6) Pancreatic Cancer Action Network, 7) ProQuest, 8) The British Medical Journal's Gut and Pancreatology, 9) Clinicaltrials.gov. The date of the last search (PubMed) was conducted on July 22, 2024. Risk of bias was assessed using the Cochrane Collaborations Risk Of Bias In Non-randomized Studies of Exposures [2] instrument. Small-study effects (publication bias, etc.) was assessed using the Doi plot and LFK index. The effect size metric for the primary outcome, PC, was the odds ratio (OR). Odd's ratios were pooled using the inverse-variance (IVhe