Clinical Significance of CA 19 - 9 for Screening of Pancreatic Cancer in Asymptomatic Subjects

Lee, Kyu Taek; Rhee, Poong Lyul; Son, Hee Jung; Lee, Jong Kyun; Lee, Joon Hyeok; Kim, Jae Jun; Koh, Kwang Cheol; Paik, Seung Woon; Rhee, Jong Chul; Shin, Myung Hee

Abstract

OBJECTIVES
Although prognosis for pancreatic cancer is generally poor, it is well known that the survival rate for resected pancreatic cancer is much higher than that for more conservative treatment. The importance of early detection is emphasized for resection of pancreatic cancer. Measurement of serum CA 19-9 has shown satisfactory sensitivity and predictive value in symptomatic patients, but there was no available data in healthy asymptomatic subjects. Thus, we aimed to determine the clinical usefulness of CA19-9 for screening of pancreatic cancer in asymptomatic subjects.
METHODS
11,974 asymptomatic persons visiting Samsung Health Promotion Center from December 1994 to July 1996 participated in this study. All subjects underwent ultrasonography and CA19-9 as initial screening tests. We analyzed sensitivity, specificity, and predictive values in detecting pancreatic cancer of CA 19-9 using statistical methods.
RESULTS
Mass screening of 11,974 asymptomatic persons resulted in the detection of only 2 cases of pancreatic cancer. 179 subjects had CA 19-9 values above the cutoff of 37u/ml, including the 2 cases diagnosed with pancreatic cancer. The prevalence of pancreatic cancer over the age of 30 in Korea is 14.8 per 100,000 population. Therefore, sensitivity is 100% and specificity is 98.5%. However, positive predictive value of CA19-9 for detection of pancreatic cancer is only 0.98% in asymptomatic population.
CONCLUSION
Mass screening of pancreatic cancer using CA 19-9 in asymptomatic subjects is ineffective due to low predictive value, despite high sensitivity and specificity.