Early Detection of Pancreatic Cancer: Opportunities and Challenges

Published on May 1, 2019in Gastroenterology17.373
· DOI :10.1053/J.GASTRO.2019.01.259
Aatur D. Singhi41
Estimated H-index: 41
(University of Pittsburgh),
Eugene J. Koay34
Estimated H-index: 34
(University of Texas MD Anderson Cancer Center)
+ 1 AuthorsAnirban Maitra136
Estimated H-index: 136
(University of Texas MD Anderson Cancer Center)
Most patients with pancreatic ductal adenocarcinoma (PDAC) present with symptomatic, surgically unresectable disease. Although 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 used 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. The last 2 categories are 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.
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