MEN1 Surveillance Guidelines: Time to (re)Think?

Paul J. Newey (Lead / Corresponding author), John Newell-Price

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)
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Abstract

Clinical Practice Guidelines for patients with Multiple Endocrine Neoplasia type 1 (MEN1) recommend a variety of surveillance options. Given progress over the past decade in this area, it is timely to evaluate their ongoing utility. MEN1 is characterized by the development of synchronous or asynchronous tumors affecting a multitude of endocrine and non-endocrine tissues, resulting in premature morbidity and mortality, such that the rationale for undertaking surveillance screening in at-risk individuals appears robust. Current guidelines recommend an intensive regimen of clinical, biochemical and radiological surveillance commencing in early childhood for those with a clinical or genetic diagnosis of MEN1, with the aim of early tumor detection and treatment. Although it is tempting to assume that such screening results in patient benefits and improved outcomes, the lack of a strong evidence base for several aspects of MEN1 care, and the potential for iatrogenic harms related to screening tests or interventions of unproven benefit, make such assumptions potentially unsound. Furthermore, the psychological, as well as economic burdens of intensive screening remain largely unstudied. Although screening undoubtedly constitutes an important component of MEN1 patient care, this perspective aims to highlight some of the current uncertainties and challenges related to existing MEN1 guidelines with a particular focus on the role of screening for pre-symptomatic tumors. Looking forward, a screening approach that acknowledges these limitations and uncertainties and places the patient at the heart of the decision-making process, is advocated.

Original languageEnglish
Article numberbvac001
Number of pages5
JournalJournal of the Endocrine Society
Volume6
Issue number2
Early online date11 Jan 2022
DOIs
Publication statusPublished - Feb 2022

Keywords

  • genetic testing
  • multiple endocrine neoplasia type 1
  • MEN1
  • surveillance
  • screening
  • pancreatic neuroendocrine tumor
  • thymic
  • bronchial neuroendocrine tumor

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