Pancreatic Cancer Screening Recommendations

Who Should Be Screened

The American Gastroenterological Association recommends that all patients with Peutz-Jeghers syndrome (carriers of LKB1/STK11 gene mutation) should undergo screening regardless of family history 1, 3
The American Gastroenterological Association recommends that all carriers of CDKN2A (p16) mutations should undergo screening 1, 3
The American Gastroenterological Association recommends that carriers of BRCA2, BRCA1, PALB2, ATM mutations with at least one affected first-degree relative (FDR) should be screened 1, 3
The American Gastroenterological Association recommends that mismatch repair gene mutation carriers (MLH1, MSH2, MSH6 - Lynch syndrome) with at least one affected FDR should be screened 1, 3
Individuals with three or more affected blood relatives with pancreatic cancer, with at least one being an FDR, should be screened 1, 4
Individuals with at least two affected FDRs with pancreatic cancer should be screened 1, 4
Individuals with two affected blood relatives with pancreatic cancer, with at least one being an FDR, should be screened 1, 4

For individuals with familial pancreatic cancer (without known genetic mutation), screening should begin at age 50 or 55 or 10 years younger than the youngest affected blood relative 1, 3
For CDKN2A and Peutz-Jeghers syndrome carriers, screening should begin at age 40 3, 5
For BRCA2, BRCA1, PALB2, ATM, and Lynch syndrome carriers, screening should begin at age 45-50 or 10 years younger than the youngest affected relative 3, 5
New-onset diabetes in a high-risk individual should prompt immediate screening regardless of age 1

Initial screening should include MRI/MRCP (Magnetic Resonance Imaging/Magnetic Resonance Cholangiopancreatography) 1, 3
Initial screening should include EUS (Endoscopic Ultrasound) 1, 3
Initial screening should include fasting blood glucose and/or HbA1c testing 1, 3
Follow-up screening should alternate between MRI/MRCP and EUS 1, 3
CA19-9 should be used as an additional test for individuals with worrisome features on imaging 1
CT should be performed only when a solid lesion is detected 1, 6
EUS-FNA (fine-needle aspiration) should be performed for solid lesions ≥5mm 1, 3
EUS-FNA should be performed for cystic lesions with worrisome features 1, 3
EUS-FNA should be performed for asymptomatic main pancreatic duct strictures 1, 3

For individuals with no abnormalities or only non-concerning abnormalities, screening intervals should be 12 months 1, 3
For individuals with concerning abnormalities that don't immediately warrant surgery, screening intervals should be 3-6 months 1, 3
For CDKN2A (p16) mutation carriers with newly detected concerning pancreatic abnormalities, repeat imaging should be performed within 3-6 months 1

Surgery is recommended when positive FNA results are obtained 3
Surgery is recommended when high suspicion of malignancy exists on imaging 3
When surgery is indicated, it should be performed at a high-volume specialty center 2, 3

The primary goal is to detect and treat stage I pancreatic cancer confined to the pancreas with negative resection margins 3
The primary goal is to detect and treat pancreatic cancer precursor lesions with high-grade dysplasia (PanIN or IPMN) 3

Screening and subsequent management should take place at high-volume centers with multidisciplinary teams, preferably within research protocols 2, 7
Small cystic lesions are commonly detected in high-risk individuals (up to 50%), but most have low malignant potential 6