Pancreatic Cancer Screening Trial

The Australian Pancreatic Cancer Screening Program (APCSP) is a research trial assessing endoscopic ultrasound (EUS) as a screening test for people with an increased risk of developing pancreatic cancer. The trial is currently recruiting specific high-risk individuals at the following locations:

  • St Vincent’s Hospital, Sydney
  • Austin Health, Melbourne
  • Epworth Healthcare – Richmond, Melbourne
  • Royal Melbourne Hospital, Melbourne
  • Royal Brisbane and Women’s Hospital, Brisbane
  • Sir Charles Gardiner Hospital, Perth
  • Hollywood Private Hospital, Perth

Why screen for pancreatic cancer?

Early detection and treatment of pancreatic cancer can significantly improve patient outcomes. However, due to the relatively low incidence of pancreatic cancer, population-based screening is not considered feasible. Many international screening programs are working together to define a population who may benefit from regular surveillance and to establish evidence-based screening protocols for families at an increased risk of pancreatic cancer.

Pancreatic cancer screening in Australia

The APCSP commenced at St Vincent’s Hospital, Sydney in 2011 and expanded to Austin Health, Melbourne in 2015. Since 2020, the trial has further expanded to additional sites in Melbourne, Brisbane and Perth.  About 350 participants are currently receiving regular research-based surveillance. The specialist gastroenterologists use EUS, a combination of endoscopy and ultrasound, to closely assess the pancreas. The aim of the trial is to determine how effectively EUS detects premalignant lesions and early pancreatic cancers in high-risk individuals.

We have published several peer-reviewed journal articles related to this research:

  1. Dwarte, T et al. (2019) Genetic counselling and personalised risk assessment in the Australian pancreatic cancer screening program. Hereditary Cancer in Clinical Practice 17:30 //doi.org/10.1186/s13053-019-0129-1
  2. O’Neill, RS et al. (2020) Long-term positive psychological outcomes in an Australian pancreatic cancer screening program. Familial Cancer 19(1):23-35 //doi.org/10.1007/s10689-019-00147-3
  3. Efthymiou, M et al. (2020) Outcomes of endoscopic ultrasound as a one-off pancreatic cancer screening tool for 122 high- and moderate-risk patients JGH Open: An open access journal of gastroenterology and hepatology 1–7 doi:10.1002/jgh3.12432
  4. O’Neill RS et al. (2020) Macrophage inhibitory cytokine-1/growth differentiation factor-15 in premalignant and neoplastic tumours in a high-risk pancreatic cancer cohort World Journal of Gastroenterology 26(14): 1660-1673 DOI: 10.3748/wjg.v26.i14.1660

    5. Murali, K et al (2021) Significant detection of new germline pathogenic variants in Australian Pancreatic Cancer Screening Program participants, Hereditary Cancer in Clinical Practice 19:33 //doi.org/10.1186/s13053-021-00190-1

    Additional articles in collaboration with all study sites are planned.

    Who is eligible for screening?

    Family history of pancreatic cancer and genetic testing results are the main predictors used to assess individuals eligible for the APCSP.

    You may be eligible to join the APCSP trial if you are aged 50-80 years* (or 10 years younger than the youngest relative diagnosed with pancreatic cancer) and fit into one of the following inclusion criteria:
    • People with two first-degree relatives affected by pancreatic cancer on the same side of the family (e.g. a parent and a sibling, two siblings)
    • People with three or more relatives affected by pancreatic cancer on the same side of the family, and a first-degree relationship with at least one affected relative

    • People who have a faulty BRCA2 gene and have a first-degree or second-degree relative with pancreatic cancer

    • People who have a faulty ATM or PALB2 gene and have a first-degree relative with pancreatic cancer
    • People with Lynch syndrome and have a first-degree relative with pancreatic cancer
    • People with Familial Atypical Multiple Mole Melanoma and have a first-degree relative with pancreatic cancer
    • People with Peutz-Jeghers syndrome (*screening from age 40)
    • People with Hereditary Pancreatitis (*screening from age 40)

    What does the study involve?

    The main components of the study include:
    • Signed consent and completion of a questionnaire on personal health and family history
    • Attending a genetic counselling session at a local Family Cancer Clinic
    • Endoscopic ultrasounds, at intervals recommended by the study gastroenterologist
    • Brief follow up questionnaires at one month, one year and five-year intervals following your first EUS
    You will be guided through the process by the site clinical coordinator, who will assist with any questions or concerns along the way.

    How do I become involved?

    The best way to find out if you are eligible for the study is to gather information about your family history and contact the screening trial coordinator. Information that will be required includes:

    • Which of your relatives have had pancreatic cancer, including their name(s), date of birth, age at diagnosis and/or age at death, where they were diagnosed or treated.
    • Which of your relatives have had other types of cancer (e.g. breast, bowel etc.), including their name(s), age at diagnosis and/or age at death, where they were diagnosed or treated.
    • Details of any genetic testing in the family that has found a faulty copy of one of the cancer predisposition genes or syndromes listed above.

    Additional information may be required to confirm the details of pancreatic cancer in relatives (e.g. medical records, death certificates). The screening trial coordinator can provide further information that can help you to obtain this information.

    If you are interested in more information about the APCSP, please contact your local screening trial coordinator:

     St Vincent’s Hospital, Sydney:

    Tanya Dwarte t.dwarte@garvan.org.au

    Royal Brisbane and Women’s Hospital, Brisbane:

    Kimberley Ryan Kimberley.Ryan@health.qld.gov.au

    Sir Charles Gardiner and Hollywood Private Hospitals, Perth:

    Amy Pearn amy.pearn@health.wa.gov.au

    Austin Health, Melbourne:

    Fau Ceunca Fau.CUENCA@austin.org.au and/or endoscopy.research@austin.org.au

    Royal Melbourne Hospital and Epworth Healthcare – Richmond, Melbourne:

    Given Lee Given.Lee@epworth.org.au and/or EHJreissatiFamilyPan@epworth.org.au

     

    Individuals wanting to find out more information about pancreatic cancer may also want to contact info@pancare.org.au.

    Further reading:

    Goggins, M et al. Management of patients with increased risk for familial pancreatic cancer: updated recommendations from the International Cancer of the Pancreas Screening (CAPS) Consortium (2020) Gut 69(1):7-17. //doi.org/10.1136/gutjnl-2019-319352

     

    APGI