Pancreatic Cancer Surveillance: Who, When, and How

Individuals who have an increased risk for pancreatic cancer (PC) due to personal or family history may benefit from surveillance of the pancreas to increase the likelihood of early detection. This review explores current indications for PC surveillance, as well as options for surveillance modality and timing, and data regarding surveillance outcomes.

Recently published data suggests that individuals undergoing surveillance who develop PC are more likely to be diagnosed with resectable disease, which improves survival. Several professional organizations have published guidelines for surveillance to help define who should have surveillance, when surveillance should be performed, and how it can be accomplished. PC surveillance should be considered for individuals with a pathogenic variant in a PC-related gene who have an affected first- or second-degree relative and for individuals in a familial pancreatic cancer family who have an affected first-degree relative. Surveillance should begin at age 50, or 10 years before the earliest age of PC diagnosis in the family. Endoscopic ultrasound (EUS) or MRI/MRCP are both reasonable surveillance options, but EUS may be better at detecting small solid changes in the pancreas. Ideally, surveillance should be performed at expert centers in conjunction with research protocols.