Surveillance for neoplasia in the pancreas
Open accessAbstract
Despite its low incidence in the general population, pancreatic cancer is one of the leading causes of cancer-related mortality. Survival greatly depends on operability, but most patients present with unresectable disease. Therefore, there is great interest in the early detection of pancreatic cancer and its precursor lesions by surveillance. Worldwide, several programs have been initiated for individuals at high risk for pancreatic cancer. Their first results suggest that surveillance in high-risk individuals is feasible, but their effectiveness in decreasing mortality remains to be proven. This review will discuss which individuals are eligible for surveillance, which lesions are aimed to be detected, and which surveillance modalities are being used in current clinical practice. Furthermore, it addresses the management of abnormalities found during surveillance and topics for future research.
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Pancreatic intraepithelial neoplasias (PanINs) are the most frequently observed precursor lesions and are microscopic, not visible on abdominal imaging.
“Pancreatic Intraepithelial Neoplasia (PanINs) are the most frequently observed precursor lesions and are, by definition, microscopic lesions that cannot be observed on abdominal imaging scans24.”
From Pancreatic cancer: Advances and challenges (2023) · cites this paper as [24]
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Self-citationPrecursor lesions in pancreatic cancer: morphological and molecular pathology
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Fruit and vegetable consumption is inversely associated with having pancreatic cancer
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Pancreatic cancer: Advances and challenges
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Long-term yield of pancreatic cancer surveillance in high-risk individuals
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Self-citationRole of BAG3 in cancer progression: A therapeutic opportunity
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“The possible contribution of BAG3, in combination with other biomarkers, for PDAC early detection appears worthy of investigation, not only for the screening of the general population, but also for the surveillance of high-risk groups, in which PDAC incidence is higher [120-121].”
BackgroundFrom Machine Learning to Patient Outcomes: A Comprehensive Review of AI in Pancreatic Cancer
Tripathi, S., Tabari, A., Mansur, A., Dabbara, H., Bridge, C. P., & Daye, D. (2024) · Diagnostics · doi:10.3390/diagnostics14020174 · Cited by 64 · see citing works
“The first, more frequent, is Pancreatic Intraepithelial Neoplasia (PanINs), which are microscopic pre-lesions that cannot currently be identified through imaging [150].”
BackgroundACR Appropriateness Criteria® Staging of Pancreatic Ductal Adenocarcinoma
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“In HPs, patients have an autosomal dominant disorder with estimated 80% phenotypic penetrance which typically results in recurrent pancreatitis with subsequent CP.[10] Overall, mutations in the cationic trypsinogen gene (R122H, N291), which cause the disease in 60%–70% of kindreds, are suggested to enhance trypsin act…”
InfluentialOverbeek, K. A., Rodríguez-Girondo, M. D. M., Wagner, A., van der Stoep, N., van den Akker, P. C., Oosterwijk, J. C., van Os, T. A. M., van der Kolk, L. E., Vasen, H. F. A., Hes, F. J., et al. (2020) · Journal of Medical Genetics · doi:10.1136/jmedgenet-2019-106562 · Cited by 31 · see citing works
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“CT is generally able to evaluate possibilities for resection, whilst it has limited diagnostic accuracy (specificity 79%) [37].”
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the Dutch Familial Pancreatic Cancer Surveillance Study Group, Overbeek, K. A., Cahen, D. L., Kamps, A., Konings, I. C. A. W., Harinck, F., Kuenen, M. A., Koerkamp, B. G., Besselink, M. G., van Eijck, C. H. J., et al. (2020) · Familial Cancer · doi:10.1007/s10689-020-00171-8 · Cited by 19 · see citing works
“However, especially in small lesions, imaging techniques may not be able to distinguish malignancy and high-grade precursors from benign disease [3, 4].”
BackgroundSelf-citationWhat’s new in the diagnosis of pancreatic cancer: a patent review (2011-present)
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Proteomics in pancreatic cancer
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“1) [15].”
An Overview for Clinicians on Intraductal Papillary Mucinous Neoplasms (IPMNs) of the Pancreas
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Maurer, E., Lehman, B., Matthäi, E., Denzer, U. W., Figiel, J. H., Jesinghaus, M., Slater, E. P., Stefenelli, U., Gress, T. M., & Bartsch, D. K. (2024) · United European Gastroenterology Journal · doi:10.1002/ueg2.12631 · Cited by 9 · see citing works
Hashimoto, A., & Hashimoto, S. (2024) · Cancers · doi:10.3390/cancers16234094 · Cited by 10 · see citing works
“PanIN is the most frequently observed precursor lesion, and is the most frequently observed metastatic lesion [76].”
Roscigno, G., Jacobs, S., Toledo, B., Borea, R., Russo, G., Pepe, F., Serrano, M. J., Calabrò, V., Troncone, G., Giovannoni, R., et al. (2025) · Seminars in Cancer Biology · doi:10.1016/j.semcancer.2025.05.003 · Cited by 8 · see citing works
“Moreover, PDACs usually derive (85 – 90 % of PDAC) from non-invasive proliferations called pancreatic intraepithelial neoplasm (PanIN) [178,179].”
Fung, A., Zaheer, A., Porter, K. K., Bashir, M. R., Cash, B. D., Chiorean, E. G., Choi, Y., Ejaz, A. M., Gage, K. L., Russo, G. K., et al. (2025) · Journal of the American College of Radiology · doi:10.1016/j.jacr.2025.08.037 · Cited by 4 · see citing works
Current status and perspectives of genetic testing in gastrointestinal cancer (Review)
Matsuoka, T., & Yashiro, M. (2023) · Oncology Letters · doi:10.3892/ol.2023.14155 · Cited by 4 · see citing works
“Risk elevates promptly depending on the number of affected family members; 4.6‑fold with one, 6.4‑fold with two, and 32‑fold with three affected FDRs (94).”
BackgroundInfluentialPrecursor lesions in familial and hereditary pancreatic cancer
Pflüger, M. J., Brosens, L. A. A., & Hruban, R. H. (2024) · Familial Cancer · doi:10.1007/s10689-024-00359-2 · Cited by 4 · see citing works
“…can and have been detected when asymptomatic high-risk individuals have been screened, and the work by Brune and colleagues discussed earlier suggests that multifocal PanINs may be clinically detectable by the pattern of chronic pancreatitis they produce on imaging [35, 36, 46, 87, 104, 106–109].”
Inherited predisposition to pancreatic cancer
Hilfrank, K. J., Rustgi, S. D., & Kastrinos, F. (2021) · Seminars in Oncology · doi:10.1053/j.seminoncol.2021.02.006 · Cited by 3 · see citing works
Neoplasias quísticas pancreáticas, enfoque diagnóstico
Pérez, R. H., López, F. D. L. M., & Vaquero, C. S. (2019) · Revista Colombiana de Gastroenterología · doi:10.22516/25007440.242 · Cited by 3 · see citing works
Screening for Pancreatic Cancer in Individuals With New-onset Diabetes Mellitus
Lo, T. (2018) · The Journal for Nurse Practitioners · doi:10.1016/j.nurpra.2018.07.010 · Cited by 1 · see citing works
Familial Predisposition and Genetic Risk Factors Associated with Pancreatic Cancer
Rustgi, S. D., Hilfrank, K. J., & Kastrinos, F. (2021) · Gastrointestinal Endoscopy Clinics of North America · doi:10.1016/j.giec.2021.09.001 · Cited by 1 · see citing works
Endoscopic ultrasonography in chronic asymptomatic pancreatic hyperenzymemia: Why not?
Antonini, F., Macarri, G., & Pezzilli, R. (2017) · Digestive and Liver Disease · doi:10.1016/j.dld.2017.08.042 · Cited by 1 · see citing works
Pancreatic Cancer Surveillance in High-risk Individuals
Jang, D. K. (2022) · Korean Journal of Gastroenterology · doi:10.4166/kjg.2022.093
Levinson, E. J., Hilfrank, K., Rustgi, S., & Kastrinos, F. (2026) · Gastroenterology Clinics of North America · doi:10.1016/j.gtc.2026.07.002
- Authors
- Overbeek, K. A., Cahen, D. L., Canto, M. I., & Bruno, M. J.
- Affiliations
- Erasmus MC (NL)
- Johns Hopkins University (US)
- Corresponding author
- Overbeek, Kasper A.
- Venue
- Best Practice & Research Clinical Gastroenterology
- Publisher
- Elsevier BV
- Published
- 2016-12
- Volume
- 30
- Issue
- 6
- Pages
- 971-986
- ISSN
- 1521-6918 (ISSN-L)
- PMC
- PMC5552042
- OpenAlex
- W2547583190
- Cited by
- 28
- References
- 147
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 5 · 2023: 2 · 2022: 1 · 2021: 5 · 2020: 3 · 2019: 1 · 2018: 1 · 2017: 6
- FWCI
- 0.27
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Best Practice & Research Clinical Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
- PubMed Central (acceptedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (P30DK089502)
- Topics
- Health Sciences › Medicine › Oncology › Pancreatic and Hepatic Oncology Research
- Health Sciences › Medicine › Surgery › Pancreatitis Pathology and Treatment
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Keywords
- pancreatic cancer, surveillance (medicine), early detection, high-risk individuals, precursor lesions, pancreatic neoplasia, surveillance programs, cancer mortality
- MeSH terms
- Humans, Neoplastic Syndromes, Hereditary, Pancreatic Neoplasms, Population Surveillance, Risk Factors, Genetic Predisposition to Disease, Early Detection of Cancer
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