Extra-pancreatic malignancies in patients with intraductal papillary mucinous neoplasms

Intraductal papillary mucinous neoplasms (IPMNs) are precursor lesions of pancreatic ductal adenocarcinoma, and clinical markers of increased risk of extra-pancreatic malignancies (EPMs). However, the true burden, organ-specific risks, and optimal screening strategies for EPMs in this population remain unclear.

This review summarizes current evidence on the association between IPMNs and EPMs, focusing on colorectal, gastric, breast, lung, and renal cancers. Geographic and ethnic differences in cancer distribution are examined, with gastric cancer predominating in East Asian populations and breast or renal cancer more common in Western cohorts. Potential mechanisms linking IPMNs to systemic carcinogenic susceptibility are discussed. A structured literature search was conducted in PubMed, Embase, Web of Science, and Cochrane Library databases for studies published up to June 2025.

Twenty-three studies (n = 9899 IPMN patients) revealed a consistently increased risk of colorectal cancer (SIRs 1.5-3.0), followed by gastric, breast, lung, and renal cancers. Gastric cancer was notably overrepresented in East Asian cohorts, while breast and renal cancers were more frequent in Western populations. Screening colonoscopy at IPMN diagnosis and upper endoscopy in East Asians are strongly supported. Broader, risk-adapted EPM surveillance integrating genetic and demographic factors is warranted.