All Patients with Pancreatic Cancer Now Meet Guidelines for Hereditary Cancer Testing

By Eleanor Griffith, MS, CGC · Jul 2018

On July 11, NCCN updated the Clinical Practice Guidelines to state that all individuals with a diagnosis of pancreatic cancer meet criteria for hereditary cancer testing — regardless of age at diagnosis or family history. Previously, an individual with pancreatic cancer met testing criteria only if they also had a relevant family history or Ashkenazi ancestry.

Why the Expanded Criteria?

Two reasons were cited: first, increasing evidence that identifying BRCA1/2 pathogenic variants may direct use of targeted therapies for patients with pancreatic cancer. Second, pancreatic cancer is highly lethal — the option to test an affected relative may not be available in the future, making testing near diagnosis important for the benefit of surviving family members.

Why Test If There Are No Great Screening Options?

While effective pancreatic cancer screening guidelines don't yet exist broadly, there are well-established screening and risk-reduction strategies for breast, ovarian, and other cancers associated with the same hereditary mutations. Identifying a mutation makes cascade testing possible — in most cases, family members who test positive for a mutation identified in a pancreatic cancer patient will actually have a relatively low risk of pancreatic cancer compared to their risks for other cancers for which intervention is possible.