TY - JOUR
T1 - Pancreatic cancer surveillance not recommended for familial adenomatous polyposis
T2 - a fine and gray risk analysis
AU - Bogdanski, Aleksander M
AU - Klatte, Derk C F
AU - Laghari, Sobia I
AU - Langers, Alexandra M J
AU - Das, Ananya
AU - Bastiaansen, Barbara A J
AU - Bonsing, Bert A
AU - Dekker, Evelien
AU - Van Hooft, Jeanin E
AU - Samadder, Jewel N
AU - Brosens, Lodewijk A A
AU - van der Geest, Lydia G
AU - Boardman, Lisa
AU - Nielsen, Maartje
AU - van Kouwen, Mariëtte C A
AU - Bisseling, Tanya M
AU - Wallace, Michael B
AU - Riegert-Johnson, Douglas
AU - van Leerdam, Monique E
N1 - Publisher Copyright:
© The Author(s), under exclusive licence to Springer Nature B.V. 2025.
PY - 2025/11/25
Y1 - 2025/11/25
N2 - Pancreatic cancer (PDAC) surveillance programs are recommended for individuals with a PDAC lifetime-risk ≥ 5% to improve outcomes. While familial adenomatous polyposis (FAP) is linked to increased PDAC risk, robust data to guide surveillance recommendations is lacking. This study evaluates PDAC risk in a large FAP-cohort.Data were collected from FAP cohorts in the United States (US) and the Netherlands (NL), including individuals (≥ 18 years) with a confirmed (likely) pathogenic APC variant. Cumulative PDAC incidence, adjusted for death as competing risk, was compared with control data from the Netherlands Cancer Registry and Statistics Netherlands. Data were collected from FAP cohorts in the United States (US) and the Netherlands (NL), including individuals (≥ 18 years) with a confirmed (likely) pathogenic APC variant. Cumulative PDAC incidence, adjusted for death as competing risk, was compared with control data from the Netherlands Cancer Registry and Statistics Netherlands. The US-cohort (n = 357) and NL-cohort (n = 1000) had a median age at the end of follow-up of 46 years (IQR, 32.0-60.0) and 60 years (IQR, 47.5-72.5), respectively. The cumulative risk of PDAC by age 70 was 1.3% (95% CI, 0.2-8.4) in the US cohort and 0.6% (95% CI 0.2-1.7) in the NL cohort. When combining both FAP-cohorts, the cumulative risk of PDAC by age 70 was 0.7% (95% CI, 0.3-1.8). For comparison, the cumulative incidence of PDAC in the general population at age 70 was 0.3% (95% CI 0.3-0.3), corresponding to a relative risk of 2.2 (95% CI, 0.9-5.7). Our findings indicate that PDAC risk in FAP patients is not statistically significantly higher than in the general population. As the cumulative incidence remains below the 5% threshold, PDAC surveillance is not recommended.
AB - Pancreatic cancer (PDAC) surveillance programs are recommended for individuals with a PDAC lifetime-risk ≥ 5% to improve outcomes. While familial adenomatous polyposis (FAP) is linked to increased PDAC risk, robust data to guide surveillance recommendations is lacking. This study evaluates PDAC risk in a large FAP-cohort.Data were collected from FAP cohorts in the United States (US) and the Netherlands (NL), including individuals (≥ 18 years) with a confirmed (likely) pathogenic APC variant. Cumulative PDAC incidence, adjusted for death as competing risk, was compared with control data from the Netherlands Cancer Registry and Statistics Netherlands. Data were collected from FAP cohorts in the United States (US) and the Netherlands (NL), including individuals (≥ 18 years) with a confirmed (likely) pathogenic APC variant. Cumulative PDAC incidence, adjusted for death as competing risk, was compared with control data from the Netherlands Cancer Registry and Statistics Netherlands. The US-cohort (n = 357) and NL-cohort (n = 1000) had a median age at the end of follow-up of 46 years (IQR, 32.0-60.0) and 60 years (IQR, 47.5-72.5), respectively. The cumulative risk of PDAC by age 70 was 1.3% (95% CI, 0.2-8.4) in the US cohort and 0.6% (95% CI 0.2-1.7) in the NL cohort. When combining both FAP-cohorts, the cumulative risk of PDAC by age 70 was 0.7% (95% CI, 0.3-1.8). For comparison, the cumulative incidence of PDAC in the general population at age 70 was 0.3% (95% CI 0.3-0.3), corresponding to a relative risk of 2.2 (95% CI, 0.9-5.7). Our findings indicate that PDAC risk in FAP patients is not statistically significantly higher than in the general population. As the cumulative incidence remains below the 5% threshold, PDAC surveillance is not recommended.
KW - Familial adenomatous polyposis
KW - Pancreatic cancer
KW - Surveillance
UR - https://www.scopus.com/pages/publications/105022762045
U2 - 10.1007/s10689-025-00512-5
DO - 10.1007/s10689-025-00512-5
M3 - Article
C2 - 41286156
SN - 1389-9600
VL - 24
JO - Familial cancer
JF - Familial cancer
IS - 4
M1 - 88
ER -