PHG Foundation | Impact of pancreatic cancer risk counselling and screening

Impact of pancreatic cancer risk counselling and screening
21 July 2010 | By Dr Susmita Chowdhury | Research article

Pancreatic cancer is the 11th commonest cancer in the UK, with around 7,800 new diagnosed cases each year (see CRUK CancerStats). Risk factors include age, family history, mutations in the BRCA2 gene, smoking, fatty and sugary diet, obesity and lack of physical activity. It is one of the least treatable cancers, with a 5-year survival rate of around 3%, and its poor diagnosis is primarily attributable to late detection. The European Registry of Hereditary Pancreatitis and Familial Pancreatic Cancer (EUROPAC) currently offers screening to individuals with an inherited predisposition to pancreatic cancer, based on imaging and blood tests.

Though active investigational screening protocols show positive outcomes for pancreatic cancer screening in high risk groups, the impact of pancreatic cancer screening on well-being is unknown. A new study has now been published investigating whether individuals participating in a pancreatic cancer screening programme experience disruptions in risk perception, cancer-related anxiety or emotional distress [Maheu et al. (2010) Fam Cancer doi:10.1007/s10689-010-9354-5].

This prospective study included 131 participants with a history of familial pancreatic cancer (FPC) and another 67 participants who were BRCA2 carriers; BRCA2 carriers were told that they had an estimated 5% lifetime risk of developing pancreatic cancer, while the FPC group was informed that they are expected to have a ‘higher’ risk than normal. Genetic counselling was provided prior to testing, in addition to information about the disease and the risks and benefits of screening. All participants were assessed at baseline and at 3 months following screening for levels of risk perception, anxiety related to pancreatic cancer and general distress.

The authors concluded that participation in a pancreatic cancer screening programme did not lead to a significant increase in risk perception, cancer worry or general distress, and that those with high baseline levels of risk perception and distress may benefit from comprehensive risk assessment and support.

Comment: This study helps to give further insight to the question of whether genetic susceptibility testing of healthy individuals causes psychological and emotional distress (see previous news). Although the authors conclude that it does not, the generalisabilty of this conclusion is questionable. The study was relatively small and lacked normal (low risk) controls, and most of the participants were affluent, well-educated Caucasian females who were actively seeking participation in a pancreatic cancer screening protocol. Additionally, the level of detailed information conveyed to the participants might not be feasible in a larger population screening programme. However, the results add to the small but gradually increasing body of literature suggesting that genetic susceptibility testing and risk prediction is minimally harmful
PHG Foundation | Impact of pancreatic cancer risk counselling and screening