Evaluation of pancreatic elastase-1 measurement during health checkups for detection of pancreatic cancer in asymptomatic individuals.

Objective: Early detection of pancreatic cancer before symptom onset improves curability. This study evaluated the utility of blood elastase-1 as a screening tool for pancreatic cancer in asymptomatic individuals.

Methods: A total of 200,583 individuals underwent health checkups at the Tokai University Hospital Health Screening Center between July 2005 and December 2018. The incidence of pancreatic cancer was compared among individuals with blood elastase-1 levels ≥401 ng/dL or <401 ng/dL at health checkups.

Results: Among 376 individuals with elastase-1 levels ≥401 ng/dL (high group), 12 were diagnosed with pancreatic cancer at our hospital. Among 200,207 records with elastase-1 levels <401 ng/dL (low group), an estimated 41 individuals developed pancreatic cancer. The sensitivity and specificity of elastase-1 testing for pancreatic cancer detection was 22.6 % and 99 %, respectively. The sensitivity of abdominal ultrasonography was 50 % and increased to 68.8 % when combined with elastase-1 testing. In patients diagnosed with pancreatic cancer, the elastase-1-high group was more likely to undergo surgery, as compared with the elastase-1-low group (75 % [9/12] vs. 50 % [10/20], statistically not signifcant, p= 0.267), and had significantly longer overall survival (median: 1113 days and 641 days).

Conclusions: Incorporating elastase-1 testing alongside abdominal ultrasonography in routine health checkups may improve the detection of pancreatic cancer in asymptomatic individuals. Patients whose pancreatic cancer was identified due to elevated elastase-1 levels had a better prognosis compared to those diagnosed through other methods.