Casey Lipton

Pancreatic Ductal Adenocarcinoma one of the least treatable forms of Cancer

Only 8% of people diagnosed diagnosed in early stages when surgical removal of tumor is possible

One-year survival rate for patients with stages three and four Pancreatic Adenocarcinoma 26% and five-year survival rate 6%

Five-year survival rate for patients with stage one or stage two Pancreatic Adenocarcinoma 23%

Male, African American patients, Jewish patients, patients between 60 and 80, patients with diabetes and patients who smoke

Ten percent of cases due to hereditary conditions◦ Peutz-Jegher’s Syndrome, Hereditary Nonpolyposis

Colorectal Cancer, BRCA 1/2 mutations, Familial Atypical Multiple Mole Melanoma Syndrome, Familial Pancreatitis

No standard screening protocol, but tests that pick up precancerous legions (i.e. EUS, MRI, CT scans)

Health History questionnaires, Doctor’s Charts and Genetic Counselors used to obtain demographic information and family history of cancer

Evaluate health history questionnaires, genetic counselor pedigrees and doctors’ charts to develop a system to classify patients into risk groups for early diagnosis

Focuses on higher and lower risk patients as opposed to just higher risk patients

Genetic counselor provides more accurate demographic information and personal and familial histories of cancer

Health history questionnaire provides more detailed on demographic information

Some patients thought to be in lower or higher risk groups should be placed in different risk groups based on questionnaires, doctor’s charts and genetic counselor risk assessments

Patients from Columbia Presbyterian Hospital Prevention group (considered higher risk) taken

from Pancreas Center Prevention and Genetics Program

Surgical Patients visited Columbia Presbyterian for surgery for Pancreatic Cancer

Patients excluded from either group if they did not have health history questionnaire, doctor’s chart or genetic counselor pedigree (Prevention Patients)

Completed by all patients with demographic information, personal and first, second and third degree relatives histories of cancer

Completed by prevention patients with mainly personal and family histories of cancer

Filled out by physicians or medical assistants for all patients with basic demographic information

Average Risk: 1 family member with pancreatic cancer who >55 years old or no family members with pancreatic cancer

Moderate Risk: 2+ first, second, or third degree relatives with pancreatic cancer or 1 first-degree relative with pancreatic cancer <55 years old

High Risk: 3+ first, second, or third degree relatives with pancreatic cancer, 2+ first-degree relatives with pancreatic cancer or 1 first and one second degree relative with pancreatic cancer <55 years old

Based on Pancreatic Cancer Screening in a Prospective Cohort of High-Risk Patients: A Comprehensive Strategy of Imaging and Genetics

Surgical Patients: compared demographic information from HHQ and Chart

Prevention Patients: compared demographic information from HHQ, chart and genetic counselor pedigree

Prevention Patients: compared personal and family histories of cancer from HHQ and genetic counselor pedigree using kappa statistical test

Risk category of each patient determined based on HHQ and genetic counselor pedigree

Amount and clarity of information analyzed to find most effective way to classify patients

61 Pancreas Prevention Patients had HHQ, Genetic Counselor and Chart data available, 33 female patients

252 Surgical Patients had HHQ and Chart data available, 112 female

Kappa values between 0.4672 and 1.000 for personal history of cancer in Prevention Program group

Kappa values between 0.7005 and 1.000 for first degree relatives histories of cancer in Prevention Program group

Kappa values between 0.312 and 0.8924 for second degree relatives histories of cancer in Prevention Program group

Kappa values between -0.0526 and 0.7248 for third degree relatives histories of cancer in Prevention Program group

22 high-risk patients, 19 moderate-risk patients, 20 average-risk patients in Prevention Program as recorded by GC

18 high-risk patients, 18 moderate-risk patients, 25 average-risk patients in Prevention Program as recorded by HHQ

3 high-risk patients, 15 moderate-risk patients, 234 average-risk patients in Surgical group as recorded by HHQ

HHQ, GC and Chart reported similar data for age, race, religion, smoking, diabetes,

HHQ asked most specific demographic questions, so little demographic information missing from Prevention and Surgical Patients

Demographic information left out of genetic counselor pedigrees and doctor’s charts because they record less biographical information

Higher level of agreement (higher kappa values) for personal history of cancer and first degree relatives’ histories of cancer

Lower level of agreement (lower kappa values) for second degree relatives’ histories of cancer and third degree relatives’ histories of cancer

Many more second and third degree relatives reported by GC

18 surgical patients who should have been placed in moderate or high-risk groups based on family histories

Genetic counselor provides more detailed information on family histories

Sending all patients to genetic counselor neither time nor cost efficient

HHQ with more specific family history questions as an intermediary step before genetic counselor meetings

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