Pancreatic cancer diagnosis and screening

Pancreatic cancer is uncommon, but is projected to become the second leading cause of cancer-related death by 2030. The dismal five year survival of 5% reflects the advanced stage of the disease at presentation, at which time surgery is not possible. The establishment of clinical and pathological diagnosis currently relies on dedicated 'pancreatic protocol' CT, MRI/cholangiopancreatography, endoscopic ultrasound and guided fine needle aspiration. Given surgical resection of early stage cancer is curative at least in some cases, the concept of screening high-risk individuals to detect the cancer at its earliest stage has been evaluated over the last 10 years. Although the advances in imaging modalities, particularly those without radiation exposure, such as endoscopic ultrasound and MRI have made screening programs safe and feasible, studies demonstrating the impact of these programs on survival outcomes are lacking. Thus, screening of high-risk individuals is not ready for widespread clinical practice and should be conducted by clinicians who have expertise in endoscopic ultrasound for screening of high-risk individuals in a research setting with prospective data collection.