There is insufficient data demonstrating improved survival to recommend routine surveillance of individuals at high familial risk of pancreatic cancer.
Most small cystic lesions found on screening will not warrant biopsy, surgical resection, or any other intervention.r However, there is accumulating evidence that surveillance might detect pre-invasive lesions which could allow for early intervention.
Recent surveillance studies showed the majority of clinically significant lesions are age related. Most pancreatic ductal adenocarcinomas reported by Canto et al. 2018 were identified in individuals aged >55 years.r Those detected at a younger age had a family history of early onset pancreatic cancer.r Bartsch et al. 2016 also found the most relevant lesions were identified in those aged >50 years.r CAPS Consortium agreed that surveillance should start no earlier than age 50, or 10 years earlier than the youngest diagnosis of pancreatic cancer.r
If surveillance is offered it should be undertaken in a high-volume centre after detailed discussion regarding limitations of screening including the high incidence of benign or indeterminate pancreatic abnormalities and uncertainties about the benefit.
The International CAPS Consortium favours annual endoscopic US or MRI/MR cholangiopancreatography for pancreatic imaging, particularly as they do not involve ionising radiation.r Endoscopic ultrasound also allows for the collection of samples to identify precursor lesions. Detection is operator dependant.
Not smoking is recommended because pancreatic cancer has a known association with smoking.