Objectives: The early-stage pancreatic cancer (e-PC; stage I/II) detection rate is quite low at approximately 25%. The aim of this study was to evaluate the feasibility of a social program (the Kishiwada Katsuragi project) wherein our hospital, which specializes in PC, and primary care medical offices (PMOs) used clinical findings to detect e-PC. Methods: Patients with a score of ≥2 points on clinical findings were enrolled: symptoms of abdominal pain/back pain (1 point), new-onset diabetes (1 point), high amylase (AMY) and/or pancreaitc AMY (P-AMY) (1 point), high carbohydrate antigen 19-9 (1 point), and ultrasonography (US) findings including direct (e.g., a solid pancreatic tumor) and/or indirect findings (e.g., dilatation of a pancreatic diameter of ≥2.5 mm and/or cystic lesions) (2 points) were evaluated using the protocol for social programs. Results: Between November 2014 and December 2016, 244 patients were enrolled by 41 PMOs as cooperative facilities, and 15 e-PC cases (53.6%) of the 28 PC patients were detected. The mean clinical finding score of the e-PC group (3.13 ± 1.9) was significantly higher than that of the overall non-PC group (2.1 ± 0.4) (p < 0.05). “High AMY/P-AMY” and “symptoms” were significantly more frequent in the e-PC group than in the non-PC group (p < 0.05). Although the sensitivity of direct findings by US was 40.0%, that of indirect-findings was 93.3% in the e-PC group. Nine and 6 of the 15 patients with e-PC were enrolled via general internal medicine offices (GIMs) and other PMOs without GIMs (general surgery, n = 3; urology, n = 2; otolaryngology, n = 1). Conclusion: This social program with collaborations between medical centers that specialize in PC and PMOs used clinical findings, suggesting that not only GIMs but also other PMOs and indirect findings by US may play an important role in improving the e-PC detection rate.

Keywords:
Pancreatic cancer, Early pancreatic cancer, Intraductal papillary mucinous neoplasm, Endoscopic ultrasound, Kishiwada Katsuragi project
1.
Egawa S,Toma H, Ohigashi H, Okusaka T, Nakao A, Hatori T, Maguchi H, Yanagisawa A, Tanaka M: Japan Pancreatic Cancer Registry; 30th year anniversary: Japan Pancreas Society. Pancreas 2012;41:985-992.
2.
D'Haese JG, Werner J: Resectability of pancreatic cancer: new criteria. Radiologe 2016;56:318-324.
3.
Yamaguchi K, Okusaka T, Shimizu K, Furuse J, Ito Y, Hanada K, Shimosegawa T: Committee for revision of clinical guidelines for pancreatic cancer of Japan Pancreas Society. EBM-based clinical guidelines for pancreatic cancer (2013) issued by the Japan Pancreatic Society: a synopsis. Jpn J Clin Oncol 2014;44:883-888.
4.
Hanada K, Okazaki A, Hirano N, Izumi Y, Teraoka Y, Ikemoto J, Kanemitsu K, Hino F, Fukuda T, Yonehara S: Diagnostic strategies for early pancreatic cancer. J Gastroenterol 2015;50:147-154.
5.
Okano K, Suzuki Y: Strategies for early detection of resectable pancreatic cancer. World J Gastroenterol 2014;20:11230-11240.
6.
Raimondi S, Lowenfels AB, Morselli-Labate AM, Maisonneuve P, Pezzilli R: Pancreatic cancer in chronic pancreatitis; aetiology, incidence and early detection. Best Prac Res Clin Gastroenterol 2010;24:349-358.
7.
McKay CJ, Glen P, McMillan DC: Chronic inflammation and pancreatic cancer. Best Pract Res Clin Gastroenterol 2008;22:65-73.
8.
Rebours V, Boutron-Ruault MC, Schnee M, Férec C, Maire F, Hammel P, Ruszniewski P, Lévy P: Risk of pancreatic adenocarcinoma in patients with hereditary pancreatitis: a national exhaustive series. Am J Gastroenterol 2008;103:111-119.
9.
Klein AP, Brune KA, Petersen GM, Goggins M, Tersmette AC, Offerhaus GJ, Griffin C, Cameron JL, Yeo CJ, Kern S, Hruban RH: Prospective risk of pancreatic cancer in familial pancreatic cancer kindreds. Cancer Res 2004;64:2634-2638.
10.
Canto MI, Harinck F, Hruban RH, Offerhaus GJ, Poley JW, Kamel I, Nio Y, Schulick RS, Bassi C, Kluijt I, Levy MJ, Chak A, Fockens P, Goggins M, Bruno M: International Cancer of Pancreas Screening (CAPS) Consortium. International Cancer of the Pancreas Screening (CAPS) consortium summit on the management of patients with increased risk for familial pancreatic cancer. Gut 2013;62:339-347.
11.
Brune KA, Lau B, Palmisano E, Canto M, Goggins MG, Hruban RH, Klein AP: Importance of age of onset in pancreatic cancer kindreds. J Nat Cancer Inst 2010;102:119-126.
12.
Pannala R, Basu A, Petersen GM, Chari ST: New-onset diabetes: a potential clue to the early diagnosis of pancreatic cancer. Lancet Oncol 2009;10:88-95.
13.
Ogawa Y, Tanaka M, Inoue K, Yamaguchi K, Chijiiwa K, Mizumoto K, Tsutsu N, Nakamura YA: A prospective pancreatographyic study of the prevalence of pancreatic carcinoma in patients with diabetes mellitus. Cancer 2002;94:2344-2349.
14.
Mizuno S, Nakai Y, Isayama H, Yanai A, Tahagara N, Miyabayashi K, Yamamoto K, Kawakubo K, Mohri D, Kogure H, Sakaki T, Yamamoto N, Sahahira N, Hirano K, Tsujino T, Ljichi H, Takeishi K, Akanuma M, Taka M, Koike K: Risk factors and early signs of pancreatic cancer in diabetes: screening strategy based on diabetes onset age. J Gastroenterol 2013;48:238-246.
15.
Pleskow DK, Berger HJ, Gyves J, Allen E, McLean A, Podolsky DK: Evaluation of a serologic marker, CA19-9, in the diagnosis of pancreatic cancer. Ann Intern Med 1989;110:704-709.
16.
Marrelli D, Caruso S, Pedrazzani C, Neri A, Fernandes E, Marini M, Pinto E, Roviello F: CA19-9 serum levels in obstructive jaundice: clinical value in benign and malignant conditions. Am J Surg 2009;198:333-339.
17.
Glenn J, Steinberg WM, Kurtzman SH, Steinberg SM, Sindelar WF: Evaluation of the utility of a radioimmunoassay for serum CA19-9 levels in patients before and after treatment of carcinoma of the pancreas. J Clin Oncol 1988;6:462-468.
18.
Nakaizumi A, Tatsuta M, Uehara H, Iishi H, Yamamura H, Okuda S, Kitamura T: A prospective trial of early detection of pancreatic cancer by ultrasonographic examination combined with measurement of serum elastase 1. Cancer 1992;69:936-940.
19.
Tanaka S, Nakao M, Ioka T, Takakura R, Takano Y, Tsukuma H, Uehara H, Suzuki R, Fukuda J: Slight dilatation of the main pancreatic duct and presence of pancreatic cysts as predictive signs of pancreatic cancer: a prospective study. Radiology 2010;254:965-972.
20.
Sakamoto H, Kitano M, Komaki T, Noda K, Chikugo T, Kudo M: Small cell carcinoma of the pancreas: role of EUS-FNA and subsequent effective chemotherapy using carboplatin and etoposide. J Gastroenterol 2009;44:432-438.
21.
Sakamoto H, Kitano M, Komaki T, Noda K, Chikugo T, Dote K, Takeyama Y, Das K, Yamao K, Kudo M: Prospective comparative study of the EUS guided 25-gauge FNA needle with the 19-gauge Trucut needle and 22-gauge FNA needle in patients with solid pancreatic masses. J Gastroenterol Hepatol 2008;55:1785-1788.
22.
Hanada K, Okazaki A, Hirano N, Izumi Y, Minami T, Ikemoto J, Kanemitsu K, Hino F: Effective screening for early diagnosis of pancreatic cancer. Best Pract Res Clin Gastroenterol 2015;29:929-939.
23.
Egawa S, Toma H, Ohigashi H, Okusaka T, Nakao A, Hatori T, Maguchi H, Yanagisawa A, Tanakan M: Japan Pancreatic Cancer Registry; 30th year anniversary: Japan Pancreas Society. Pancreas 2012;41:985-992.
24.
Chiang KC, Yeh CN, Lee WC, Jan YY, Hwang TL: Prognostic analysis of patients with pancreatic head adenocarcinoma less than 2 cm undergoing resection. World J Gastroenterol 2009;15:4305-4310.
25.
Homma T, Tsuchiya R: The study of the mass screening of persons without symptoms and of the screening of outpatients with gastrointestinal complains or icterus for pancreatic cancer in Japan, using CA19-9 and elastase-1 or ultrasonography. Int J Pancreatol 1991;9:119-124.
26.
Lopez Hänninen E, Amthauer H, Hosten N, Ricke J, Böhmig M, Langrehr J, Hintze R, Neuhaus P, Wiedenmann B, Rosewicz S, Felix R: Prospective evaluation of pancreatic tumors: accuracy of MR imaging with MR cholangiopancreatography and MR angiography. Radiology 2002;224:34-41.
27.
Adamek HE, Albert J, Breer H, Weitz M, Schilling D, Riemann JF: Pancreatic cancer detection with magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography: a prospective controlled study. Lancet 2000;356:190-193.
28.
Holzapfel K, Reiser-Erkan C, Fingerle AA, Erkan M, Eiber MJ, Rummeny EJ, Friess H, Kleeff J, Gaa J: Comparison of diffusion-weighted MR imaging and multidetector-row CT in the detection of liver metastases in patients operated for pancreatic cancer. Abdom Imaging 2011:36:179-184.
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