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Identifying key factors for the effectiveness of pancreatic cancer screening: A model-based analysis.
Koopmann, Brechtje D M; Harinck, Femme; Kroep, Sonja; Konings, Ingrid C A W; Naber, Steffie K; Lansdorp-Vogelaar, Iris; Fockens, Paul; van Hooft, Jeanin E; Cahen, Djuna L; van Ballegooijen, Marjolein; Bruno, Marco J; de Kok, Inge M C M.
Affiliation
  • Koopmann BDM; Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
  • Harinck F; Department of Gastroenterology & Hepatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
  • Kroep S; Department of Gastroenterology & Hepatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
  • Konings ICAW; Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
  • Naber SK; Department of Gastroenterology & Hepatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
  • Lansdorp-Vogelaar I; Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
  • Fockens P; Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
  • van Hooft JE; Department of Gastroenterology & Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
  • Cahen DL; Department of Gastroenterology & Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
  • van Ballegooijen M; Department of Gastroenterology & Hepatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
  • Bruno MJ; Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
  • de Kok IMCM; Department of Gastroenterology & Hepatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Int J Cancer ; 149(2): 337-346, 2021 07 15.
Article in En | MEDLINE | ID: mdl-33644856
Pancreatic cancer (PC) survival is poor, as detection usually occurs late, when treatment options are limited. Screening of high-risk individuals may enable early detection and a more favorable prognosis. Knowledge gaps prohibit establishing the effectiveness of screening. We developed a Microsimulation Screening Analysis model to analyze the impact of relevant uncertainties on the effect of PC screening in high-risk individuals. The model simulates two base cases: one in which lesions always progress to PC and one in which indolent and faster progressive lesions coexist. For each base case, the effect of annual and 5-yearly screening with endoscopic ultrasonography/magnetic resonance imaging was evaluated. The impact of variance in PC risk, screening test characteristics and surgery-related mortality was evaluated using sensitivity analyses. Screening resulted in a reduction of PC mortality by at least 16% in all simulated scenarios. This reduction depended strongly on the natural disease course (annual screening: -57% for "Progressive-only" vs -41% for "Indolent Included"). The number of screen and surveillance tests needed to prevent one cancer death was impacted most by PC risk. A 10% increase in test sensitivity reduced mortality by 1.9% at most. Test specificity is important for the number of surveillance tests. In conclusion, screening reduces PC mortality in all modeled scenarios. The natural disease course and PC risk strongly determines the effectiveness of screening. Test sensitivity seems of lesser influence than specificity. Future research should gain more insight in PC pathobiology to establish the true value of PC screening in high-risk individuals.
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Full text: 1 Database: MEDLINE Main subject: Pancreatic Neoplasms / Early Detection of Cancer Type of study: Diagnostic_studies / Etiology_studies / Prognostic_studies / Risk_factors_studies / Screening_studies Limits: Humans / Male Language: En Year: 2021 Type: Article

Full text: 1 Database: MEDLINE Main subject: Pancreatic Neoplasms / Early Detection of Cancer Type of study: Diagnostic_studies / Etiology_studies / Prognostic_studies / Risk_factors_studies / Screening_studies Limits: Humans / Male Language: En Year: 2021 Type: Article