Outcomes of Surveillance Program for Individuals at High-Risk of Pancreatic Adenocarcinoma

Individuals at high-risk (HRI) of developing pancreatic adenocarcinoma (PDAC) are offered intensive screening to detect PDAC at an early, curable stage. There is scant data on how HRI PDAC screening programs perform in clinical practice outside of large, prospective cohort studies. This study assessed the screening patterns, outcomes, and adherence of HRIs participating in a structured PDAC screening program.

We conducted a retrospective cohort study of HRIs at a single, quaternary care referral center between 2009-2025. Based on risk factors, patients were offered structured testing with non-invasive imaging (most commonly magnetic resonance imaging, MRI) and/or endoscopic ultrasound (EUS). Demographic and clinical information was obtained through chart review. Adherence rates were calculated, and a multivariable analysis was conducted to identify factors associated with adherence.

316 patients met high-risk criteria and underwent screening. Seven PDACs were detected during a mean cohort follow up of 2.5 years; six early-stage PDACs (four stage I, two stage II) were detected during surveillance, and one stage III PDAC was diagnosed due to symptoms in a patient non-adherent to screening. Seven patients underwent surgical resection, including four with PDAC and three with worrisome lesions on imaging or endoscopic ultrasound (two high-risk cystic lesions and one PanIN-IB). There was one death from PDAC in a patient with stage IA disease who didn't undergo resection. The mean adherence rate for the cohort was 76.5% over 3.8 years. Individuals with pathogenic germline variants demonstrated higher adherence (P=0.02).

A PDAC screening program for HRIs identified early stage PDAC in an important proportion of patients. While overall adherence rates are high, additional research is needed to identify barriers affecting patient adherence.