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Brief Evidence Update
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Systematic reviews of the evidence serve as the basis for U.S. Preventive Services Task Force (USPSTF) recommendations on clinical prevention topics. The USPSTF tailors the scope of these reviews to each topic. The USPSTF determined that a brief, focused evidence review was needed to assist in updating its 1996 recommendations on screening for pancreatic cancer.1
Jana Johnson of the RTI-UNC Evidence-based Practice Center (under contract to AHRQ), performed a targeted review of the literature published on this topic between 1994 and 2001
The MEDLINE® and the Cochrane Library databases were searched for articles dating from 1994 through December, 2001, focusing on systematic reviews, meta-analyses, randomized controlled trials (RCTs), cost-effectiveness analyses, editorials, or commentaries concerning the critical key questions. The National Guideline Clearinghouse™ was also searched for guidelines on this topic.
In the MEDLINE® search, pancreatic cancer and mass screening were exploded, combining these searches with RCT terms. A second search used treatment (including chemotherapy and surgery) in place of screening. Studies of test accuracy (sensitivity and specificity) regarding screening for pancreatic cancer were also searched for.
Key Questions and Results
Key Question 1: Is there new direct evidence that screening provides more benefit than harm?
We examined 44 abstracts but found no RCTs, meta-analyses, or systematic reviews that provided direct evidence about the benefits and harms of screening.
Key Question 2: Are there new tests (or new evidence about old tests) that substantially improve the accuracy of screening?
We examined 73 abstracts but found no study that provided high quality evidence about the accuracy of screening tests to detect pancreatic cancer early.
Key Question 3: Are there new treatments (or new evidence about old treatments) that improve outcomes for people with pancreatic cancer?
We examined 25 abstracts and found 2 papers that describe an ongoing randomized trial in Europe evaluating 3 different adjuvant treatments for pancreatic cancer.2,3 As of that point in 1997, 348 patients had been recruited into the 3 treatment arms and 1 control arm of the study.
There is little new evidence and no critical ongoing studies of screening for pancreatic cancer. The literature mentions ongoing research on identifying and screening high-risk groups, especially those with tumor markers. Ongoing research regarding treatment involves studies to determine the effectiveness of new adjuvant chemotherapy, radiation, and surgery protocols. Few of these studies are RCTs.
Recommendations of Professional Organizations
The Canadian Task Force recommendation can be accessed at: http://www.ctfphc.org.
The American Academy of Family Physician's recommendations can be accessed at: http://www.aafp.org/online/en/home/clinical/clinicalrecs.html
The American Cancer Society recommendations can be accessed at: http://www.cancer.org
2. Neoptolemos JP, Kerr DJ, Beger H, et al. ESPAC-1 trial progress report: the European randomized adjuvant study comparing radiochemotherapy, 6 months chemotherapy and combination therapy versus observation in pancreatic cancer. Digestion 1997;58:570-7.
3. Neoptolemos JP, Baker P, Beger H, et al. Progress report. A randomized multicenter European study comparing adjuvant radiotherapy, 6-mo chemotherapy, and combination therapy vs no-adjuvant treatment in resectable pancreatic cancer (ESPAC-1). Int J Pancreatol 1997;21:97-104.
This brief update and the updated recommendations of the USPSTF are available through the AHRQ Web site (http://www.uspreventiveservicestaskforce.org) and through the National Guideline Clearinghouse™ (http://www.guideline.gov).
Recommendations made by the USPSTF are independent of the U.S. Government. They should not be construed as an official position of AHRQ or the U.S. Department of Health and Human Services.
Copyright, Reprinting, and Linking Information
This document is in the public domain within the United States. Requests for linking or to incorporate content in electronic resources should be sent via the USPSTF contact form.
Current as of February 2004
U.S. Preventive Services Task Force. Screening for Pancreatic Cancer: Brief Evidence Update. February 2004. http://www.uspreventiveservicestaskforce.org/3rduspstf/pancreatic/pancreup.htm