TABLE 3.
Effect of different PC screening strategies on life expectancy
| Risk group | Screening method | Screening interval | Age | Treatment mortality (%) | Effect on LE (days) per simulated individual | Reference |
|---|---|---|---|---|---|---|
| General population | MRI (sens. 56%, spec. 97%, for detection of cyst and early stage PC. No PanIN) | One time | 40 | 2 | −5.1 to −5.8 a | 9 |
| 50 | 2 | −3.3 to −4.0 a | ||||
| 10 | −27 to −31 a | |||||
| 1 | 2 to 3 a | |||||
| 60 | 2 | −2.2 to −2.9 a | ||||
| 70 | 2 | −1.5 to −1.8 a | ||||
| MRI (sens. 25%, spec. 97%, for detection of cyst and early stage PC. No PanIN) | One time | 50 | 2 | −4 to −5 a | ||
| MRI (sens. 56%, spec. 50%, for detection of cyst and early stage PC. No PanIN) | One time | 50 | 2 | −94 to −110 a | ||
| MRI (sens. 56%, spec. 100%, for detection of cyst early stage PC. No PanIN) | One time | 50 | 2 | 2 | ||
| MRI (sens. 100%, spec. 97%, for detection of cyst and early stage PC. No PanIN. | One time | 50 | 2 | −2 | ||
| Hypothetical perfect test for PanIN3 | Continuous | 50 | 0 | 40 | 11 | |
| 2 | 37 | |||||
| One time | 50 | 0 | 7.1 | |||
| 2 | 6.7 | |||||
| 60 | 0 | 10 | ||||
| 2 | 9.3 | |||||
| 70 | 0 | 7.9 | ||||
| 2 | 7 |
| Inherited increased risk for PC | ||||||
|---|---|---|---|---|---|---|
| RR 2.4‐4.5 | MRI (sens. 56%, spec. 97%, for detection of cyst and early stage PC. No PanIN) | One time | 50 | 1 | 3.9 to 5.8 | 10 |
| Annual | 50 | 1 | −12.9 to −1.3 | |||
| RR 6.4/life time risk 7.5% | MRI (sens. 56%, spec. 97%, for detection of cyst and early stage PC. No PanIN) | One time | 50 | 1 | 9.1 | 10 |
| Annual (50–80) | 50 | 1 | 20.6 | |||
| MRI + EUS (sens. per disease stage [60–99%], spec. 90%) | Annual | 50 | 3 | 120.4‐158.4 b | 13 | |
| MRI + EUS (sens. per disease stage [60‐99%], spec. 90%) | 5‐yearly | 50 | 3 | 48.6‐90.4 b | ||
| RR 12 (PC life time risk 18%) | EUS (sens. 90%, for detection of pancreatic dysplasia) | One time | 50 | 3 | 138.7 | 12 |
| RR 30‐32 | MRI (sens. 56%, spec. 97%, for detection of cyst and early stage PC. No PanIN) | One time | 50 | 1 | 31.5 | 10 |
| 2 | 65 to 71 a | 9 | ||||
| Annual | 50 | 1 | 260 | 10 | ||
| RR 70 | MRI (sens. 56%, spec. 97%, for detection of early stage PC) | One time | 50 | 2 | 160 to 181 a | 9 |
| PC | Hypothetical screening reducing stage III/IV cancer with 20% | NA | NA | NA | 54.7 | 16 |
| Hypothetical screening reducing stage III/IV cancer with 30% | NA | NA | NA | 82.1 | ||
| Hypothetical screening reducing stage III/IV cancer with 50% | NA | NA | NA | 152 | ||
| Pancreatic cyst | Test mortality (%) | |||||
|---|---|---|---|---|---|---|
| Cyst (1‐3 cm c ) | CT/MRI (Detecting HGD + PC. Probability true pos. = 0.80, true neg. = 0.99) | Annual | 65 | 0 | 17 to 439 | 15 |
| 75 | 0 | 9 to 50 | ||||
| 85 | 0 | 3 to 54 | ||||
| EUS ± FNA (Detecting HGD + PC. Probability true pos. = 0.86, true neg. = 0.99) | Annual | 65 | 0.01 | 18 to 445 | ||
| 75 | 0.01 | 10 to 55 | ||||
| 85 | 0.01 | 4 to 59 | ||||
| SB‐IPMN | Imaging | Annual | 60 | 0 | 161 to 195 | 17 |
| 80 | 0 | 69 |
Note: The effect on LE is visible in days lost or gained per simulated individual entering screening. Morality risk is either caused by screentest (EUS) or by treatment (surgery after positive screentest).
Abbreviations: CT, computed tomography; EUS, endoscopic ultrasound; HGD, high grade dysplasia; MRI, magnetic resonance imaging; Neg., negative; PanIN, Pancreatic Intraepithelial Neoplasia; PC, pancreatic cancer; Pos., positive; RR, relative risk; SB‐IPMN, Side Branch—Intraductal Papillary Mucinous Neoplasm; Sens., sensitivity; Spec., specificity.
Effect on life expectancy for men and women.
In this model two pathways are simulated, one with only progressive lesions and one with indolent and faster progressive lesions. A larger effect on LE was seen in the progressive‐only pathway.
LYG are presented in years per patient in ranges correlated with cyst size (1 cm less gain, 3 cm, more gain in LE).