Pancreatic cancer has a low survival rate due to most cases being diagnosed at late stages. This study evaluated using health history questionnaires, doctors' charts, and genetic counselor assessments to classify patients' risk levels to help identify high-risk individuals for early screening. Results found health history questionnaires provided the most detailed demographic information. Genetic counselors provided more comprehensive family cancer histories. Combining health history questionnaires with genetic counseling may help identify more high-risk patients for screening.

1. Casey Lipton

2.  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%

3.  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

4.  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

5.  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

6.  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

7.  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)

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

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

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

11.  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

12.  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

14.  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

16.  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

18.  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

19.  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

20.  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

21.  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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