Aspects and outcomes of surveillance for individuals at high-risk of pancreatic cancer

Abstract

Pancreatic ductal adenocarcinoma (PDAC) is a leading cause of cancer-related deaths and is associated with a poor prognosis. The majority of these cancers are detected at a late stage, contributing to the bad prognosis. This underscores the need for novel, enhanced early detection strategies to improve the outcomes. While population-based screening is not recommended due to the relatively low incidence of PDAC, surveillance is recommended for individuals at high risk for PDAC due to their increased incidence of the disease. However, the outcomes of pancreatic cancer surveillance in high-risk individuals are not sorted out yet. In this review, we will address the identification of individuals at high risk for PDAC, discuss the objectives and targets of surveillance, outline how surveillance programs are organized, summarize the outcomes of high-risk individuals undergoing pancreatic cancer surveillance, and conclude with a future perspective on pancreatic cancer surveillance and novel developments.

Keywords: Early detection; High-risk individuals; Pancreatic cancer surveillance; Pancreatic ductal adenocarcinoma.

Fig. 1

Overview of pancreatic cancer surveillance in high-risk individuals based on CAPS guidelines [9]. High-risk individuals undergo annual surveillance. Upon detection of new concerning lesions, EUS with FNA/FNB or CT is performed to assess the potential malignancy of the lesion. If malignancy is suspected, surgery is recommended. The positive indicators of malignancy are shown in the adjacent table. Conversely, when malignancy is not indicated, individuals transition into a shortened surveillance protocol. The shortening of the surveillance interval depends upon the characteristics of the lesion and is illustrated in the corresponding tables. CT computerized tomography, FNA fine needle aspiration, FNB fine needle biopsy, MPD main pancreatic duct dilatation. Created with BioRender.com