Department of Surgery, Washington University in St. Louis, St. Louis, Missouri.
Cancer Prev Res (Phila). 2021 Mar;14(3):373-382. doi: 10.1158/1940-6207.CAPR-20-0426. Epub 2020 Nov 3.
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.
预计到 2020 年，胰腺癌将成为美国第二大致癌相关死亡原因。因此，人们对开发一种能够在长时间无症状期间识别个体的筛查测试产生了浓厚的兴趣，并投入了大量的研究资金；然而，迄今为止，尚未开发出这样的测试。我们评估了美国国立卫生研究院目前的支出和临床试验，以确定与其他癌症亚型相比，胰腺癌筛查的研究重点。我们使用统计方法确定了基于人群的胰腺癌筛查对总体人群发病率和死亡率的影响。基于人群的胰腺癌筛查即使在开发出近乎完美的测试的情况下，也会对非患病个体造成严重伤害。尽管这种数学上的可能性极小，但美国国立卫生研究院对胰腺癌的资助表明，与其他癌症亚型相比，其对筛查测试开发存在偏见。将研究重点放在开发胰腺癌筛查测试上不太可能带来总体生存获益。增加适合手术的患者数量并改善手术结果将带来更大的人群获益。对于患有胰腺癌的患者，早期检测可带来最大的生存获益。然而，胰腺癌的发病率和相关的胰腺切除术死亡率使得开发筛查测试成为一项艰巨的挑战，如果不是不可能的话。
