Abdominal Imaging of Pancreatic Cysts and Cyst-Associated Pancreatic Cancer in BRCA1/2 Mutation Carriers: A Retrospective Cross-Sectional Study

Abstract Background Direct-to-consumer BRCA testing will increase BRCA diagnoses and subsequent abdominal imaging. It is unclear whether BRCA-carriers are at higher risk of developing pancreatic cysts (PCs) or cyst-associated pancreatic adenocarcinoma (PDAC). We investigate the prevalence of PCs in BRCA-tested patients, and whether BRCA-carriers have higher rates of PDAC when PCs are found. Study Design This is a retrospective cross-sectional study of patients with BRCA testing and abdominal imaging between 1996-2018. PCs were identified on original imaging reports. Prevalence and risk characteristics of PCs, as well as incidence of PDAC, were compared between BRCA+, BRCA-, and BRCA-untested patients. Results PCs were identified in 4045 patients among 128,164 unique patients with abdominal imaging, including 33 patients with PCs in 1,113 BRCA-tested patients. There was no difference in PC prevalence between BRCA+, BRCA- and untested patients (3.6%, 2.6%, 3.2% respectively; p= 0.64). PCs were diagnosed in BRCA+ patients at a younger age (57.1 vs 65.3 years, p Conclusion BRCA+ patients have similar rates of PCs, high-risk features in their cysts, and PDAC as BRCA- and untested patients. BRCA+ patients likely do not require dedicated abdominal imaging to evaluate for PCs and should follow similar management guidelines as the untested general population if an incidental PC is identified.