Areas of Uncertainty in Pancreatic Cancer Surveillance: A Survey Across the International Pancreatic Cancer Early Detection (PRECEDE) Consortium.

Abstract

Pancreatic cancer (PC) surveillance is increasingly recommended for high-risk individuals, but there are remaining areas of uncertainty that are not consistently addressed by guidelines contributing to heterogeneity in clinical practice. Herein, we compare PC surveillance practices across sites in the international Pancreatic Cancer Early Detection (PRECEDE) Consortium to understand the application of eligibility criteria and testing strategies among experienced PC surveillance centers. This analysis represents a cross-sectional survey administered in 2024 to PRECEDE institutions. The site principal investigator (or designee) completed the survey reflecting PC surveillance practices of their site, with one response per institution. Survey questions were related to surveillance eligibility for carriers of <i>BRCA1/2</i>, <i>ATM</i>, <i>PALB2</i>, and Lynch syndrome along with imaging approaches. Of the 57 PRECEDE sites, 54 (95%) completed the survey. For high-risk gene carriers, there was heterogeneity among sites with respect to whether family history of PC was used when assessing eligibility for surveillance. In the absence of family history, 44.4% and 35.2% of sites would offer PC surveillance to <i>BRCA2</i> and <i>BRCA1</i> carriers, respectively, whereas 31.5% and 13% would offer surveillance to <i>PALB2/ATM</i> and Lynch syndrome carriers, respectively. There was general consensus that surveillance should start at age 50 for men and women across all included genes. Magnetic resonance imaging with magnetic resonance cholangiopancreatography was used by 64.8% of sites as index imaging. The majority recommended an alternative modality if index imaging was unremarkable, and recommended annual surveillance imaging. This is the largest assessment of global PC surveillance practices to date, showing variability in practice patterns. Additional investigation is needed to refine risk stratification for gene carriers without a family history of PC and address optimal imaging strategies.