Pancreatic Cancer Screening and Early Detection: Where Are We Now?

Pancreatic cancer remains one of the most lethal malignancies, with an overall 5-year survival rate of approximately 13%. The poor prognosis is primarily due to late-stage diagnosis, as early-stage disease is often asymptomatic. Screening for pancreatic cancer in high-risk individuals offers the potential for early detection, timely intervention, and improved survival outcomes. Individuals at elevated risk for pancreatic cancer-that is, those with a family history or predisposing genes for pancreatic cancer or certain inherited syndromes and patients with precursor lesions or precancerous lesions-are considered suitable candidates for screening. Imaging is recognized as an important tool for diagnosis and staging of pancreatic cancer. Evidence supports use of endoscopic US, MRI, and CT as primary imaging modalities to facilitate early detection. Screening intervals and imaging strategies vary in high-risk individuals and those with precursor or precancerous lesions. While conventional imaging plays a key role in diagnosis and staging, it often fails to allow detection of visually occult disease, an area where artificial intelligence-enhanced imaging offers potential. These advancements have the potential to improve detection of early pancreatic cancer with prediagnostic CT and MRI. In parallel, the development of novel serum biomarkers with greater sensitivity and specificity provides promising avenues for noninvasive screening. Despite these advances, there remains a critical unmet need for validated, cost-effective, and scalable tools. The authors aim to critically appraise current screening strategies, highlight emerging technologies in imaging and biomarkers, and discuss their potential to transform early detection and improve clinical outcomes in high-risk populations. © The Author(s) 2026. Published by the Radiological Society of North America under a CC BY 4.0 license See the invited commentary by Luk and Flusberg in this issue.