Reply to S. Raoof

Mohamad Dbouk; Bryson W Katona; Randall E Brand; Amitabh Chak; Sapna Syngal; James J Farrell; Fay Kastrinos; Elena M Stoffel; Marcia Irene Canto; Michael Goggins

doi:10.1200/JCO.22.01915

. 2022 Oct 31;41(5):1147–1149. doi: 10.1200/JCO.22.01915

Reply to S. Raoof

Mohamad Dbouk, MD

¹Mohamad Dbouk, MD, Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD; Bryson W. Katona, MD, Division of Gastroenterology, Department of Medicine, Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Randall E. Brand, MD, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA; Amitabh Chak, MD, Division of Gastroenterology and Liver Disease, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH; Sapna Syngal, MD, Cancer Genetics and Prevention Division, Medical Oncology, Dana-Farber Cancer Institute, Division of Gastroenterology, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; James J. Farrell, MD, Yale Center for Pancreatic Disease, Section of Digestive Disease, Yale University, New Haven, CT; Fay Kastrinos, MD, Division of Digestive and Liver Diseases, Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY; Elena M. Stoffel, MD, Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI; Marcia Irene Canto, MD, Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, Department of Medicine, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD; and Michael Goggins, MB, MD, Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, Department of Medicine, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD

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¹, Bryson W Katona

Bryson W Katona, MD

¹Mohamad Dbouk, MD, Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD; Bryson W. Katona, MD, Division of Gastroenterology, Department of Medicine, Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Randall E. Brand, MD, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA; Amitabh Chak, MD, Division of Gastroenterology and Liver Disease, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH; Sapna Syngal, MD, Cancer Genetics and Prevention Division, Medical Oncology, Dana-Farber Cancer Institute, Division of Gastroenterology, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; James J. Farrell, MD, Yale Center for Pancreatic Disease, Section of Digestive Disease, Yale University, New Haven, CT; Fay Kastrinos, MD, Division of Digestive and Liver Diseases, Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY; Elena M. Stoffel, MD, Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI; Marcia Irene Canto, MD, Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, Department of Medicine, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD; and Michael Goggins, MB, MD, Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, Department of Medicine, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD

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¹, Randall E Brand

Randall E Brand, MD

¹Mohamad Dbouk, MD, Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD; Bryson W. Katona, MD, Division of Gastroenterology, Department of Medicine, Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Randall E. Brand, MD, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA; Amitabh Chak, MD, Division of Gastroenterology and Liver Disease, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH; Sapna Syngal, MD, Cancer Genetics and Prevention Division, Medical Oncology, Dana-Farber Cancer Institute, Division of Gastroenterology, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; James J. Farrell, MD, Yale Center for Pancreatic Disease, Section of Digestive Disease, Yale University, New Haven, CT; Fay Kastrinos, MD, Division of Digestive and Liver Diseases, Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY; Elena M. Stoffel, MD, Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI; Marcia Irene Canto, MD, Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, Department of Medicine, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD; and Michael Goggins, MB, MD, Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, Department of Medicine, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD

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¹, Amitabh Chak

Amitabh Chak, MD

¹Mohamad Dbouk, MD, Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD; Bryson W. Katona, MD, Division of Gastroenterology, Department of Medicine, Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Randall E. Brand, MD, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA; Amitabh Chak, MD, Division of Gastroenterology and Liver Disease, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH; Sapna Syngal, MD, Cancer Genetics and Prevention Division, Medical Oncology, Dana-Farber Cancer Institute, Division of Gastroenterology, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; James J. Farrell, MD, Yale Center for Pancreatic Disease, Section of Digestive Disease, Yale University, New Haven, CT; Fay Kastrinos, MD, Division of Digestive and Liver Diseases, Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY; Elena M. Stoffel, MD, Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI; Marcia Irene Canto, MD, Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, Department of Medicine, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD; and Michael Goggins, MB, MD, Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, Department of Medicine, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD

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¹, Sapna Syngal

Sapna Syngal, MD

¹Mohamad Dbouk, MD, Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD; Bryson W. Katona, MD, Division of Gastroenterology, Department of Medicine, Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Randall E. Brand, MD, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA; Amitabh Chak, MD, Division of Gastroenterology and Liver Disease, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH; Sapna Syngal, MD, Cancer Genetics and Prevention Division, Medical Oncology, Dana-Farber Cancer Institute, Division of Gastroenterology, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; James J. Farrell, MD, Yale Center for Pancreatic Disease, Section of Digestive Disease, Yale University, New Haven, CT; Fay Kastrinos, MD, Division of Digestive and Liver Diseases, Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY; Elena M. Stoffel, MD, Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI; Marcia Irene Canto, MD, Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, Department of Medicine, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD; and Michael Goggins, MB, MD, Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, Department of Medicine, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD

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¹, James J Farrell

James J Farrell, MD

¹Mohamad Dbouk, MD, Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD; Bryson W. Katona, MD, Division of Gastroenterology, Department of Medicine, Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Randall E. Brand, MD, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA; Amitabh Chak, MD, Division of Gastroenterology and Liver Disease, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH; Sapna Syngal, MD, Cancer Genetics and Prevention Division, Medical Oncology, Dana-Farber Cancer Institute, Division of Gastroenterology, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; James J. Farrell, MD, Yale Center for Pancreatic Disease, Section of Digestive Disease, Yale University, New Haven, CT; Fay Kastrinos, MD, Division of Digestive and Liver Diseases, Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY; Elena M. Stoffel, MD, Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI; Marcia Irene Canto, MD, Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, Department of Medicine, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD; and Michael Goggins, MB, MD, Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, Department of Medicine, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD

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¹, Fay Kastrinos

Fay Kastrinos, MD

¹Mohamad Dbouk, MD, Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD; Bryson W. Katona, MD, Division of Gastroenterology, Department of Medicine, Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Randall E. Brand, MD, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA; Amitabh Chak, MD, Division of Gastroenterology and Liver Disease, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH; Sapna Syngal, MD, Cancer Genetics and Prevention Division, Medical Oncology, Dana-Farber Cancer Institute, Division of Gastroenterology, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; James J. Farrell, MD, Yale Center for Pancreatic Disease, Section of Digestive Disease, Yale University, New Haven, CT; Fay Kastrinos, MD, Division of Digestive and Liver Diseases, Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY; Elena M. Stoffel, MD, Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI; Marcia Irene Canto, MD, Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, Department of Medicine, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD; and Michael Goggins, MB, MD, Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, Department of Medicine, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD

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¹, Elena M Stoffel

Elena M Stoffel, MD

¹Mohamad Dbouk, MD, Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD; Bryson W. Katona, MD, Division of Gastroenterology, Department of Medicine, Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Randall E. Brand, MD, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA; Amitabh Chak, MD, Division of Gastroenterology and Liver Disease, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH; Sapna Syngal, MD, Cancer Genetics and Prevention Division, Medical Oncology, Dana-Farber Cancer Institute, Division of Gastroenterology, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; James J. Farrell, MD, Yale Center for Pancreatic Disease, Section of Digestive Disease, Yale University, New Haven, CT; Fay Kastrinos, MD, Division of Digestive and Liver Diseases, Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY; Elena M. Stoffel, MD, Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI; Marcia Irene Canto, MD, Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, Department of Medicine, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD; and Michael Goggins, MB, MD, Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, Department of Medicine, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD

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¹, Marcia Irene Canto

Marcia Irene Canto, MD

¹Mohamad Dbouk, MD, Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD; Bryson W. Katona, MD, Division of Gastroenterology, Department of Medicine, Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Randall E. Brand, MD, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA; Amitabh Chak, MD, Division of Gastroenterology and Liver Disease, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH; Sapna Syngal, MD, Cancer Genetics and Prevention Division, Medical Oncology, Dana-Farber Cancer Institute, Division of Gastroenterology, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; James J. Farrell, MD, Yale Center for Pancreatic Disease, Section of Digestive Disease, Yale University, New Haven, CT; Fay Kastrinos, MD, Division of Digestive and Liver Diseases, Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY; Elena M. Stoffel, MD, Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI; Marcia Irene Canto, MD, Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, Department of Medicine, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD; and Michael Goggins, MB, MD, Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, Department of Medicine, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD

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¹, Michael Goggins

Michael Goggins, MB, MD

¹Mohamad Dbouk, MD, Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD; Bryson W. Katona, MD, Division of Gastroenterology, Department of Medicine, Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Randall E. Brand, MD, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA; Amitabh Chak, MD, Division of Gastroenterology and Liver Disease, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH; Sapna Syngal, MD, Cancer Genetics and Prevention Division, Medical Oncology, Dana-Farber Cancer Institute, Division of Gastroenterology, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; James J. Farrell, MD, Yale Center for Pancreatic Disease, Section of Digestive Disease, Yale University, New Haven, CT; Fay Kastrinos, MD, Division of Digestive and Liver Diseases, Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY; Elena M. Stoffel, MD, Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI; Marcia Irene Canto, MD, Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, Department of Medicine, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD; and Michael Goggins, MB, MD, Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, Department of Medicine, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD

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^1,^✉

¹Mohamad Dbouk, MD, Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD; Bryson W. Katona, MD, Division of Gastroenterology, Department of Medicine, Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Randall E. Brand, MD, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA; Amitabh Chak, MD, Division of Gastroenterology and Liver Disease, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH; Sapna Syngal, MD, Cancer Genetics and Prevention Division, Medical Oncology, Dana-Farber Cancer Institute, Division of Gastroenterology, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA; James J. Farrell, MD, Yale Center for Pancreatic Disease, Section of Digestive Disease, Yale University, New Haven, CT; Fay Kastrinos, MD, Division of Digestive and Liver Diseases, Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY; Elena M. Stoffel, MD, Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI; Marcia Irene Canto, MD, Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, Department of Medicine, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD; and Michael Goggins, MB, MD, Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, Department of Medicine, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD

^✉

Corresponding author: Michael Goggins, MB, MD, Johns Hopkins Medical Institutions, CRB2 351, 1550 Orleans St, Baltimore, MD 21231; Twitter: @mggoggins; e-mail: mgoggins@jhmi.edu.

PMCID: PMC9928686 PMID: 36315911

We thank Dr Raoof¹ for her interest and comments on our Multicenter Cancer of the Pancreas Screening (CAPS) study which is designed to evaluate long-term outcomes of pancreas surveillance and to develop better biomarkers for early detection. Raoof¹ comments about outcomes of nonpancreatic cancers reported in our article.² Our analysis of this question is ongoing, but it is worth emphasizing that although overall cancer is much higher than pancreatic cancer incidence, cancer mortality is not; most patients diagnosed with pancreatic cancer outside of surveillance die of their disease. With regard to the perspective of multicancer early detection (MCED) tests versus single-cancer screening approaches, several points are worth emphasizing.

First, the magnetic resonance imaging/magnetic resonance cholangiopancreatography and endoscopic ultrasound tests used for pancreas surveillance are multicancer detection tests; EUS not only yields high-resolution images of the pancreas, but also images the upper GI tract, liver, and biliary tree, whereas magnetic resonance imaging (or sometimes computed tomography), provides fuller imaging of the abdomen. In earlier CAPS studies, we reported on the detection of other early-stage asymptomatic cancers,³ and in ongoing analysis, we are examining the question of other early-stage cancers detected by these tests and their relative yield.

It is also worth noting that patients in the CAPS program are subject to many factors that influence uptake of cancer screening tests, including insurance and other barriers to care that can affect outcomes, not only for pancreas cancer,⁴ but for other cancers as well. For many, their CAPS surveillance is undertaken at a referral center separate from their local health care system. As such, these other cancer outcomes reflect real-world data, and in recent times, these were likely affected by the COVID-19 pandemic. We agree with the goal of assessing and reporting competing risks; estimating these cancer risks is an ongoing work, not only of the CAPS program but also of other cohorts and of cancer registry data, such as the National Familial Pancreas Tumor Registry.⁵

As to overall cancer risk, patients in the CAPS program are counseled about their other cancer surveillance using evidence-based guidelines individualized for their mutation status and family history⁶; thus, our patients typically undergo multiple other single-cancer screening approaches to detect breast, colorectal, and other cancers. These early detection approaches offer better opportunities for the detection of stage I disease and cancer cure than circulating tumor DNA (ctDNA)–based MCED tests. Contrasting total cancer incidence with the apparent limitation of single-cancer screening approaches could be misinterpreted as indicating that the MCED approaches are superior, which remains to be demonstrated. Indeed, in the best clinical trial addressing this question, the Detect-A study⁷ found that only a minority of cancers detected by MCED were early-stage—this is not surprising since tumor-derived circulating analytes tend to reflect tumor burden and most stage I cancers are not detectable with current ctDNA-based tests.⁸ The very high specificity requirement of a multianalyte early detection screening test, especially an MCED test, lowers diagnostic sensitivity, thereby limiting the detection of the smallest tumors. The best MCED tests have performed well, but the tradeoffs involved, including the number of positive tests that are judged to be false positives after subsequent workup, will vary by population and require clinical trial evaluation.⁹ Although the ctDNA-based MCED tests have potential to detect a variety of cancers, as shown in the Detect-A study, many of the other cancers reported in our recent CAPS article would likely not be identified by an MCED test, and for many of the other cancer types, their exist general population (breast, colorectal, prostate, and cervical) or high-risk group (ovarian and lung) screening tests. Perhaps the most promising need that ctDNA-based MCED tests could fulfill is providing an option for those who choose not to undergo some of, or all of the most accurate cancer screening tests.

Patients undergoing pancreas surveillance in the CAPS program and elsewhere should be offered the best evidence-based recommendations regarding screening for other cancers. As it stands, current MCED tests do not have the diagnostic performance to replace existing early cancer detection strategies proven to decrease cancer mortality. Clinical trials are needed to determine how blood tests, such as ctDNA-based MCED tests, could be used to improve pancreas and other cancer surveillance. Within the CAPS program, we have opened one such trial that aims to assess the value of a tumor marker gene test as a complement to existing pancreas imaging surveillance.¹⁰ In the near future, studies may show that blood tests such as MCED tests may be valuable for those who decline current standard-of-care tests and those at intermediate cancer risk, such as those who do not meet current pancreas surveillance criteria, and might play a role in improving the yield of existing cancer detection strategies.

ACKNOWLEDGMENT

Supported by NIH grants (U01210170, R01CA176828, CA62924). This work was also supported by the Pancreatic Cancer Action Network, the V Foundation, Susan Wojcicki and Dennis Troper, the Lustgarten Foundation, Smith Family Research Fund, the Uehara Memorial Foundation, the Bowen-Chapman Fund, and a Stand Up To Cancer-Lustgarten Foundation Pancreatic Cancer Interception Translational Cancer Research Grant (Grant No.: SU2C-AACR-DT25-17). Stand Up To Cancer is a program of the Entertainment Industry Foundation. SU2C research grants are administered by the American Association for Cancer Research, the scientific partner of SU2C. M.G. is the Sol Goldman Professor of Pancreatic Cancer Research. The funders had no role in study design or implement or in manuscript preparation.

Bryson W. Katona

Other Relationship: Janssen, Immunovia, Epigenomics, Guardant, Freenome, Universal diagnostics

Uncompensated Relationships: Invitae, Ambry, GeneDx

Randall E. Brand

Consulting or Advisory Role: Immunovia, Freenome (Inst)

Research Funding: Immunovia (Inst), Freenome (Inst)

Amitabh Chak

Stock and Other Ownership Interests: Lucid Diagnostics

Honoraria: CDx Diagnostics

Consulting or Advisory Role: US Endoscopy, Microtek

Research Funding: STERIS

Patents, Royalties, Other Intellectual Property: Methods and compositions for detecting gastrointestinal and other cancers US 8415100 B2. Sanford D. Markowitz, Joseph Willis, Amitabh Chak, Rom Leidner Pending: 2012272697 (Australia), EP 12802150.8 (Europe), 2,840,324 (Canada) Device for Collecting a Biological Sample: Amitabh Chak, Rebecca Blice, Sanford D. Markowitz, Dean Secrest, Dennis Siedlak, Jeffrey Taggart, Joseph E Willis Pending: PCT/US14/070060 Methylated Markers of Esophageal Neoplasia. Amitabh Chak, Omar de la Cruz, Thomas LaFramboise, Sanford D. Markowitz, Helen Moinova, Joseph E Willis Pending: 62/099,021 (Inst)

Sapna Syngal

Patents, Royalties, Other Intellectual Property: Dana-Farber Cancer Institute has a registered service mark for the PREMM5 model and holds copyrights for the PREMM questionnaires (Inst), Myriad Genetics (through Dana-Farber Cancer Institute) paid an inventor share of the IP (license issue fee)

Expert Testimony: GlaxoSmithKline

James J. Farrell

Honoraria: Immunovia

Consulting or Advisory Role: Cook Medical

Research Funding: Immunovia

Fay Kastrinos

Consulting or Advisory Role: Ambry Genetics/Konica Minolta, Immunovia, Iterative Scopes

Research Funding: Immunovia, Janssen

Elena M. Stoffel

Research Funding: Cancer Prevention Pharmaceuticals (Inst)

Marcia Irene Canto

Consulting or Advisory Role: Castle Biosciences, Bluestar Genomics

Research Funding: Pentax Medical Corporation (Inst), EndoGastric Solutions (Inst)

Patents, Royalties, Other Intellectual Property: Royalties from UpToDate, online

Michael Goggins

Patents, Royalties, Other Intellectual Property: Royalty related to licensing as a codiscoverer of PALB2 as a pancreatic cancer susceptibility gene to Myriad Genetics

No other potential conflicts of interest were reported.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

Reply to S. Raoof

The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated unless otherwise noted. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/authors/author-center.

Open Payments is a public database containing information reported by companies about payments made to US-licensed physicians (Open Payments).

Bryson W. Katona

Other Relationship: Janssen, Immunovia, Epigenomics, Guardant, Freenome, Universal diagnostics

Uncompensated Relationships: Invitae, Ambry, GeneDx

Randall E. Brand

Consulting or Advisory Role: Immunovia, Freenome (Inst)

Research Funding: Immunovia (Inst), Freenome (Inst)

Amitabh Chak

Stock and Other Ownership Interests: Lucid Diagnostics

Honoraria: CDx Diagnostics

Consulting or Advisory Role: US Endoscopy, Microtek

Research Funding: STERIS

Patents, Royalties, Other Intellectual Property: Methods and compositions for detecting gastrointestinal and other cancers US 8415100 B2. Sanford D. Markowitz, Joseph Willis, Amitabh Chak, Rom Leidner Pending: 2012272697 (Australia), EP 12802150.8 (Europe), 2,840,324 (Canada) Device for Collecting a Biological Sample: Amitabh Chak, Rebecca Blice, Sanford D. Markowitz, Dean Secrest, Dennis Siedlak, Jeffrey Taggart, Joseph E Willis Pending: PCT/US14/070060 Methylated Markers of Esophageal Neoplasia. Amitabh Chak, Omar de la Cruz, Thomas LaFramboise, Sanford D. Markowitz, Helen Moinova, Joseph E Willis Pending: 62/099,021 (Inst)

Sapna Syngal

Patents, Royalties, Other Intellectual Property: Dana-Farber Cancer Institute has a registered service mark for the PREMM5 model and holds copyrights for the PREMM questionnaires (Inst), Myriad Genetics (through Dana-Farber Cancer Institute) paid an inventor share of the IP (license issue fee)

Expert Testimony: GlaxoSmithKline

James J. Farrell

Honoraria: Immunovia

Consulting or Advisory Role: Cook Medical

Research Funding: Immunovia

Fay Kastrinos

Consulting or Advisory Role: Ambry Genetics/Konica Minolta, Immunovia, Iterative Scopes

Research Funding: Immunovia, Janssen

Elena M. Stoffel

Research Funding: Cancer Prevention Pharmaceuticals (Inst)

Marcia Irene Canto

Consulting or Advisory Role: Castle Biosciences, Bluestar Genomics

Research Funding: Pentax Medical Corporation (Inst), EndoGastric Solutions (Inst)

Patents, Royalties, Other Intellectual Property: Royalties from UpToDate, online

Michael Goggins

Patents, Royalties, Other Intellectual Property: Royalty related to licensing as a codiscoverer of PALB2 as a pancreatic cancer susceptibility gene to Myriad Genetics

No other potential conflicts of interest were reported.

REFERENCES

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[b1] 1. Raoof S. Winning the battle but losing the war: Single-cancer screening trials. J Clin Oncol. 2023;41:1147. doi: 10.1200/JCO.22.01668. [DOI] [PubMed] [Google Scholar]

[b2] 2.Dbouk M, Katona BW, Brand RE, et al. The multicenter cancer of pancreas screening study: Impact on stage and survival J Clin Oncol40:3257-3266, 2022 [DOI] [PMC free article] [PubMed] [Google Scholar]

[b3] 3. Canto MI, Goggins M, Hruban RH, et al. Screening for early pancreatic neoplasia in high-risk individuals: A prospective controlled study. Clin Gastroenterol Hepatol. 2006;4:766–781. doi: 10.1016/j.cgh.2006.02.005. [DOI] [PubMed] [Google Scholar]

[b4] 4. Blackford AL, Canto MI, Klein AP, et al. Recent trends in the incidence and survival of stage 1A pancreatic cancer: A Surveillance, Epidemiology, and End Results analysis. J Natl Cancer Inst. 2020;112:1162–1169. doi: 10.1093/jnci/djaa004. [DOI] [PMC free article] [PubMed] [Google Scholar]

[b5] 5. Wang L, Brune KA, Visvanathan K, et al. Elevated cancer mortality in the relatives of patients with pancreatic cancer. Cancer Epidemiol Biomarkers Prev. 2009;18:2829–2834. doi: 10.1158/1055-9965.EPI-09-0557. [DOI] [PMC free article] [PubMed] [Google Scholar]

[b6] 6. Daly MB, Pal T, Berry MP, et al. Genetic/familial high-risk assessment: Breast, ovarian, and pancreatic, version 2.2021, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2021;19:77–102. doi: 10.6004/jnccn.2021.0001. [DOI] [PubMed] [Google Scholar]

[b7] 7. Lennon AM, Buchanan AH, Kinde I, et al. Feasibility of blood testing combined with PET-CT to screen for cancer and guide intervention. Science. 2020;369:eabb9601. doi: 10.1126/science.abb9601. [DOI] [PMC free article] [PubMed] [Google Scholar]

[b8] 8. Hackshaw A, Clarke CA, Hartman AR. New genomic technologies for multi-cancer early detection: Rethinking the scope of cancer screening. Cancer Cell. 2022;40:109–113. doi: 10.1016/j.ccell.2022.01.012. [DOI] [PubMed] [Google Scholar]

[b9] 9. Etzioni R, Gulati R, Weiss NS. Multicancer early detection: Learning from the past to meet the future. J Natl Cancer Inst. 2022;114:349–352. doi: 10.1093/jnci/djab168. [DOI] [PMC free article] [PubMed] [Google Scholar]

[b10] 10. Abe T, Koi C, Kohi S, et al. Gene variants that affect levels of circulating tumor markers increase identification of patients with pancreatic cancer. Clin Gastroenterol Hepatol. 2020;18:1161–1169.e5. doi: 10.1016/j.cgh.2019.10.036. [DOI] [PMC free article] [PubMed] [Google Scholar]

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Reply to S. Raoof

Mohamad Dbouk, MD

Bryson W Katona, MD

Randall E Brand, MD

Amitabh Chak, MD

Sapna Syngal, MD

James J Farrell, MD

Fay Kastrinos, MD

Elena M Stoffel, MD

Marcia Irene Canto, MD

Michael Goggins, MB, MD

ACKNOWLEDGMENT

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

Reply to S. Raoof

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PERMALINK

Reply to S. Raoof

Mohamad Dbouk, MD

Bryson W Katona, MD

Randall E Brand, MD

Amitabh Chak, MD

Sapna Syngal, MD

James J Farrell, MD

Fay Kastrinos, MD

Elena M Stoffel, MD

Marcia Irene Canto, MD

Michael Goggins, MB, MD

ACKNOWLEDGMENT

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

Reply to S. Raoof

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