Early Detection of Pancreatic Cancer: Opportunities and Challenges

The vast majority of patients with pancreatic ductal adenocarcinoma (PDAC) presents with symptomatic, surgically unresectable disease. While the goal of early detection of PDAC is laudable, and likely to result in significant improvement in overall survival, the relatively low prevalence of PDAC renders general population screening infeasible. The challenges of early detection include identification of at-risk individuals in the general population who would benefit from longitudinal surveillance programs, and appropriate biomarker and imaging-based modalities utilized for PDAC surveillance in such cohorts. In recent years, various subgroups at higher than average risk for PDAC have been identified, including those with familial risk due to germline mutations, a history of pancreatitis, patients with mucinous pancreatic cysts, and elderly patients with new onset diabetes (NOD). The last two categories will be discussed at length in terms of the opportunities and challenges they present for PDAC early detection. We also discuss current and emerging imaging modalities that are critical to identifying early, potentially curable, PDAC in high-risk cohorts on surveillance.