Screening for Pancreatic Ductal Adenocarcinoma: Are We Asking the Impossible?

• Published in: Cancer prevention research (Philadelphia, Pa.) Pa.), 2021-03, Vol.14 (3), p.373-382
• Main Authors: Caldwell, Katharine E, Conway, Alexander P, Hammill, Chet W
• Format: Article
• Language: English
• Subjects: Biomedical Research - economics; Breast Neoplasms - diagnosis; Breast Neoplasms - economics; Breast Neoplasms - epidemiology; Breast Neoplasms - surgery; Carcinoma, Pancreatic Ductal - diagnosis; Carcinoma, Pancreatic Ductal - economics; Carcinoma, Pancreatic Ductal - epidemiology; Carcinoma, Pancreatic Ductal - surgery; Colonic Neoplasms - diagnosis; Colonic Neoplasms - economics; Colonic Neoplasms - epidemiology; Colonic Neoplasms - surgery; Early Detection of Cancer - economics; Early Detection of Cancer - methods; Early Detection of Cancer - standards; Female; Humans; Incidence; Models, Theoretical; Pancreatectomy - mortality; Pancreatic Neoplasms - diagnosis; Pancreatic Neoplasms - economics; Pancreatic Neoplasms - epidemiology; Pancreatic Neoplasms - surgery; Prognosis; Research Support as Topic - statistics & numerical data; Risk Factors; Survival Rate; United States - epidemiology
• ISSN: 1940-6207; 1940-6215
• DOI: 10.1158/1940-6207.CAPR-20-0426

Pancreatic cancer is projected to become the second leading cause of cancer-related death in the United States by 2020. Because of this, significant interest and research funding has been devoted to development of a screening test to identify individuals during a prolonged asymptomatic period; however, to date, no such test has been developed. We evaluated current NIH spending and clinical trials to determine the focus of research on pancreatic cancer screening as compared with other cancer subtypes. Using statistical methodology, we determined the effects of population-based pancreatic cancer screening on overall population morbidity and mortality. Population-based pancreatic cancer screening would result in significant harm to non-diseased individuals, even in cases where a near-perfect test was developed. Despite this mathematical improbability, NIH funding for pancreatic cancer demonstrates bias toward screening test development not seen in other cancer subtypes. Focusing research energy on development of pancreatic screening tests is unlikely to result in overall survival benefits. Efforts to increase the number of patients who are candidates for surgery and improving surgical outcomes would result in greater population benefit. For patients with pancreatic cancer, early stage detection offers the greatest survival benefit. However, the incidence of pancreatic cancer and associated mortality of pancreatic resections make development of a screening test a difficult, if not impossible, challenge.