Can our experience with surveillance for inherited pancreatic cancer help to identify early pancreatic cancer in the general population?

Sep 21, 2026

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General population cancer screening is a cornerstone of primary prevention, yet pancreatic cancer poses distinct challenges. Unlike cancers where accessible examinations and established blood-based tests exist, the pancreas is difficult to evaluate with simple physical assessment or inexpensive biomarkers. Reviewing evidence from surveillance studies in pancreatic cancer risk groups, the evidence currently does not support rational screening of the general population due to the absence of appropriate, cost-effective tests.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages5

Reading Time13 min

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Introduction

Screening individuals at risk

Health economy

Familial Cancer (2024) 23:399–403 [https://doi.org/10.1007/s10689-024-00363-6](https://doi.org/10.1007/s10689-024-00363-6) REVIEW Can our experience with surveillance for inherited pancreatic cancer help to identify early pancreatic cancer in the general population? J.-Matthias Löhr1,6 · Daniel Öhlund2 · Emma Söreskog3 · Emil Andersson1 · Miroslav Vujasinovic1 · Niklas Zethraeus3 · Malin Sund4,5 Received: 2 December 2023 / Accepted: 5 February 2024 / Published online: 5 March 2024 © The Author(s) 2024 Abstract Screening of the general population for cancer is a matter of primary prevention reducing the burden of disease. Whilst this is successful for several cancers including breast, colon and prostate, the situation to screen and hence prevent pancreatic cancer is different. The organ is not as accessible to simple physical exam or biological samples (fecal or blood test) . Neither exists a blood test such as PSA that is cost-effective. Reviewing the evidence from screening risk groups for pancreatic cancer, one must conclude that there is no rational at present to screen the general population, for a lack of appropriate tests. Keywords Pancreatic cancer · Surveillance · General population · Screening · Individuals at risk · Incidental finding Introduction The question of whether experience from pancreatic cancer surveillance programs can help us to detect pancreatic cancer in the general population does, obviously, imply that such screening will be able to identify patients at early enough stages to allow for curative surgery and, if necessary, adjuvant chemotherapy. 􀀍 J.-Matthias Löhr [matthias.lohr@ki.se](matthias.lohr@ki.se) 1 Karolinska Comprehensive Cancer Center and Karolinska Institutet, Stockholm, Sweden 2 Department of Radiation Sciences and Wallenberg Centre for Molecular Medicine (WCMM), Umeå University, Umeå, Sweden 3 Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden 4 Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland 5 Department of Surgical and Perioperative Sciences/ Surgery, Umeå University, Umeå, Sweden 6 Div. of Surgery & Oncology, Dept. of Upper Abdominal Diseases, CLINTEC Karolinska Institutet, Karolinska Comprehensive Cancer Center, Stockholm SE-141 86, Sweden We therefore should first investigate the evidence from the screening programs in these risk populations for the detection of early cancer since here the risk to develop pancreatic cancer is higher. Consensus guidelines for individuals at risk (IAR) are developed by the international Cancer of the Pancreas Screening (CAPS) Consortium [1] . This group ofIAR is better suited compared to other risk groups such as patients with chronic [2] or autoimmune [3] pancreatitis or patients with IPMN [4] that all are at risk to develop pancreatic cancer. The ground truth being surgical pathology demonstrating high-grade dysplasia or T1a invasive cancer as a reference. Screening programs usually consist of imaging at regular intervals, mostly by using MRI, with or without the addition of biomarkers such as CA 19–9 [5] . Screening individuals at risk The aim of the screening of IAR is the detection and diagnosis of preneoplastic lesions, such as intraductal papillary mucinous neoplasia (IPMN), pancreatic intraepithelial neoplasia (PanIN) with high-grade dysplasia (HGD), or earlystage pancreatic ductal adenocarcinoma (PDAC) . Several studies published by the CAPS Consortium have analyzed the prevalence of pancreatic abnormalities, preneoplastic lesions and pancreatic cancer, as well as the risk of malignant progression of IAR under surveillance [6, 7] Click or tap here to enter text. These studies show that IAR often have small cystic lesions [6] and that neoplastic progression (either HGD or pancreatic cancer) occurred in 7% with a progression rate of 1.6%/year [7] . Asymptomatic pancreatic cancers detected under surv

FAQs

Why is screening the general population for pancreatic cancer different from screening for other cancers?

The pancreas is less accessible to simple physical examinations or routine biological samples, and there is no cost-effective blood test analogous to PSA for prostate cancer.

What is the goal of surveillance for individuals at risk (IAR)?

The aim is early detection and diagnosis of preneoplastic lesions (such as IPMN and PanIN with high-grade dysplasia) and early-stage PDAC.

What evidence suggests that surveillance in IAR can detect cancer at an early, treatable stage?

Surveillance studies reported that neoplastic progression occurred in a minority of participants, that many asymptomatic cancers were identified in early and resectable phases, and that this corresponded with improved survival compared with symptomatic cancers developing outside surveillance.

Sep 21, 2026

Upload by Noah