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Cited by 490Pancreatic and Hepatic Oncology ResearchPancreatitis Pathology and TreatmentGlobal Cancer Incidence and Screening

Early detection of pancreatic cancer

Open access
Pereira, Stephen P, Oldfield, Lucy, Ney, Alexander, Hart, Phil A, Keane, Margaret G, Pandol, Stephen J, Li, Debiao, Greenhalf, William +6 more·2020·The Lancet Gastroenterology & Hepatology
DOI 10.1016/s2468-1253(19)30416-9PMC PMC7380506
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Abstract

Pancreatic ductal adenocarcinoma is most frequently detected at an advanced stage. Such late detection restricts treatment options and contributes to a dismal 5-year survival rate of 3–15%. Pancreatic ductal adenocarcinoma is relatively uncommon and screening of the asymptomatic adult population is not feasible or recommended with current modalities. However, screening of individuals in high-risk groups is recommended. Here, we review groups at high risk for pancreatic ductal adenocarcinoma, including individuals with inherited predisposition and patients with pancreatic cystic lesions. We discuss studies aimed at finding ways of identifying pancreatic ductal adenocarcinoma in high-risk groups, such as among individuals with new-onset diabetes mellitus and people attending primary and secondary care practices with symptoms that suggest this cancer. We review early detection biomarkers, explore the potential of using social media for detection, appraise prediction models developed using electronic health records and research data, and examine the application of artificial intelligence to medical imaging for the purposes of early detection.

Verified 2026-10-06 · 1 reference not checked yet

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Crossref · 10.1016/s2468-1253(19)30416-9

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Claims the paper makes

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  • Premisecitation

    Incidentally diagnosed pancreatic ductal adenocarcinoma is associated with longer median survival than pancreatic ductal adenocarcinoma diagnosed when patients have symptoms.

    “Similarly, incidentally diagnosed pancreatic ductal adenocarcinoma (ie, discovered serendipitously while screening or checking for other diseases) is associated with longer median survival than pancreatic ductal adenocarcinoma that is diagnosed when patients have symptoms.8”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [8] Poruk KE, Firpo MA, Adler DG, Mulvihill SJ. Screening for pancreatic cancer: why, how, and who? Ann Surg 2013; 257: 17– 26. 22895395 PMC4113008 source

      Not checked in the free run.

  • Premisecitation

    Patients diagnosed with stage 1 pancreatic ductal adenocarcinoma survive longer than patients diagnosed at more advanced stages.

    “Patients diagnosed with stage 1 disease experience longer survival times than patients diagnosed with disease at more advanced stages.8”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [8] Poruk KE, Firpo MA, Adler DG, Mulvihill SJ. Screening for pancreatic cancer: why, how, and who? Ann Surg 2013; 257: 17– 26. 22895395 PMC4113008 source

      Not checked in the free run.

  • Premisecitation

    Up to 85% of patients with pancreatic ductal adenocarcinoma have cancers that are not surgically resectable when identified.

    “Unfortunately, up to 85% of patients have cancers that are not surgically resectable when identified, and over half of patients in the UK are diagnosed following a non-specific disease course leading to an emergency hospital admission.10–13”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [10] Keane MG, Horsfall L, Rait G, Pereira SP. A case-control study comparing the incidence of early symptoms in pancreatic and biliary tract cancer. BMJ Open 2014; 4: e005720. PMC4244441 25410605 source

      Not checked in the free run.

    • cites [11] Zhou Y, Abel GA, Hamilton W, Diagnosis of cancer as an emergency: a critical review of current evidence. Nat Rev Clin Oncol 2017; 14: 45– 56. 27725680 source

      Not checked in the free run.

    • cites [12] Hippisley-Cox J, Coupland C. Identifying patients with suspected pancreatic cancer in primary care: derivation and validation of an algorithm. Br J Gen Pract 2012; 62: e38– 45. 22520674 PMC3252538 source

      Not checked in the free run.

    • cites [13] Stapley S, Peters TJ, Neal RD, Rose PW, Walter FM, Hamilton W. The risk of pancreatic cancer in symptomatic patients in primary care: a large case-control study using electronic records. Br J Cancer 2012; 106: 1940– 44. 22617126 PMC3388562 source

      Not checked in the free run.

  • Premisecitation

    The 5-year survival rate for pancreatic ductal adenocarcinoma is 3-15%.

    “a dismal 5-year survival rate of 3–15%”
    • Also stated in: § Introduction · plain
      “the 5-year survival rates remain as low as 3–15%.3,4”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [3] Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68: 394– 424. 30207593

      Not checked in the free run.

    • cites [4] Arnold M, Rutherford MJ, Bardot A, Progress in cancer survival, mortality, and incidence in seven high-income countries 1995–2014 (ICBP SURVMARK-2): a population-based study. Lancet Oncol 2019; 20: 1493– 505. 31521509 PMC6838671 source

      Not checked in the free run.

  • Premisecitation

    Over half of patients in the UK are diagnosed with pancreatic ductal adenocarcinoma after a non-specific disease course leading to emergency hospital admission.

    “over half of patients in the UK are diagnosed following a non-specific disease course leading to an emergency hospital admission.10–13”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [10] Keane MG, Horsfall L, Rait G, Pereira SP. A case-control study comparing the incidence of early symptoms in pancreatic and biliary tract cancer. BMJ Open 2014; 4: e005720. PMC4244441 25410605 source

      Not checked in the free run.

    • cites [11] Zhou Y, Abel GA, Hamilton W, Diagnosis of cancer as an emergency: a critical review of current evidence. Nat Rev Clin Oncol 2017; 14: 45– 56. 27725680 source

      Not checked in the free run.

    • cites [12] Hippisley-Cox J, Coupland C. Identifying patients with suspected pancreatic cancer in primary care: derivation and validation of an algorithm. Br J Gen Pract 2012; 62: e38– 45. 22520674 PMC3252538 source

      Not checked in the free run.

    • cites [13] Stapley S, Peters TJ, Neal RD, Rose PW, Walter FM, Hamilton W. The risk of pancreatic cancer in symptomatic patients in primary care: a large case-control study using electronic records. Br J Cancer 2012; 106: 1940– 44. 22617126 PMC3388562 source

      Not checked in the free run.

  • May combine two claims. 32
  • Classified as probably not a substantial claim. 20

  • May combine two claims.

    Premisecitation

    Screening high-risk groups increases the detection rate and reduces false-positive results.

    “Screening individuals in high-risk groups increases the rate of detection and reduces false-positive results.8”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [8] Poruk KE, Firpo MA, Adler DG, Mulvihill SJ. Screening for pancreatic cancer: why, how, and who? Ann Surg 2013; 257: 17– 26. 22895395 PMC4113008 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    High-risk groups for pancreatic ductal adenocarcinoma include people with inherited predisposition, people with pancreatic cystic lesions, and people older than 50 years with newly diagnosed type 2 diabetes.

    “Here, we review groups at high risk for pancreatic ductal adenocarcinoma, including individuals with inherited predisposition and patients with pancreatic cystic lesions.”
    • Also stated in: § Introduction · plain
      “Several groups at high risk of pancreatic ductal adenocarcinoma have been identified, including individuals in families with an inherited risk,17,18 people with cystic lesions of the pancreas,19–21 and people older than 50 years, newly diagnosed with type 2 diabetes.22,23”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [17] Petersen GM. Familial pancreatic adenocarcinoma. Hematol Oncol Clin North Am 2015; 29: 641– 53. 26226902 PMC4522044 source

      Not checked in the free run.

    • cites [18] Canto MI, Almario JA, Schulick RD, Risk of neoplastic progression in individuals at high risk for pancreatic cancer undergoing long-term surveillance. Gastroenterology 2018; 155: 740– 51.e2. 29803839 PMC6120797 source

      Not checked in the free run.

    • cites [19] Kimura W, Moriya T, Hirai I, Multicenter study of serous cystic neoplasm of the Japan pancreas society. Pancreas 2012; 41: 380– 87. 22415666 source

      Not checked in the free run.

    • cites [20] Del Chiaro M, Verbeke C, Salvia R, European experts consensus statement on cystic tumours of the pancreas. Dig Liver Dis 2013; 45: 703– 11. 23415799 source

      Not checked in the free run.

    • cites [21] Vege SS, Ziring B, Jain R, Moayyedi P, Clinical Guidelines Committee, American Gastroenterology Association. American gastroenterological association institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology 2015; 148: 819– 22; quize12–3. 25805375 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Pancreatic ductal adenocarcinoma is usually found after it has reached an advanced stage, which limits treatment options and contributes to poor survival.

    “Pancreatic ductal adenocarcinoma is most frequently detected at an advanced stage. Such late detection restricts treatment options and contributes to a dismal 5-year survival rate of 3–15%.”
    • Also stated in: § Introduction · plain
      “These dismal figures are attributed to late-stage and incurable-stage diagnosis as well as high tumour chemoresistance.5”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [5] Kamisawa T, Wood LD, Itoi T, Takaori K. Pancreatic cancer. Lancet 2016; 388: 73– 85. 26830752 source

      Not checked in the free run.

  • May combine two claims.

    Premisereasoning

    Screening asymptomatic adults at average risk for pancreatic ductal adenocarcinoma is not feasible or recommended with current modalities.

    “Pancreatic ductal adenocarcinoma is relatively uncommon and screening of the asymptomatic adult population is not feasible or recommended with current modalities.”
    • Also stated in: § Introduction · plain
      “The low disease prevalence makes screening of the asymptomatic adult population unfeasible. Existing diagnostic methods would incur unacceptably high rates of false-positive findings,16”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [16] Hart PA, Chari ST. Is screening for pancreatic cancer in high-risk individuals one step closer or a fool’s errand? Clin Gastroenterol Hepatol 2019; 17: 36– 38. 30268560 PMC6557281 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Premisenone given

    Screening individuals in high-risk groups is recommended.

    “However, screening of individuals in high-risk groups is recommended.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Increasing knowledge about the genetic progression of intraductal papillary mucinous neoplasms suggests that early lesions are heterogeneous, whereas lesions with high-grade dysplasia have a smaller number of homogeneous driver genes.

    “There is increasing knowledge about the progression of intraductal papillary mucinous neoplasms from a genetic perspective, which suggests that early lesions are heterogeneous, whereas lesions with high-grade dysplasia have a smaller number of homogeneous driver genes.42”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [42] Fischer CG, Beleva Guthrie V, Braxton AM, Intraductal papillary mucinous neoplasms arise from multiple independent clones, each with distinct mutations. Gastroenterology 2019; 157: 1123– 37.e22. 31175866 PMC6756950

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Familial pancreatic cancer is defined as having multiple first-degree relatives with pancreatic ductal adenocarcinoma, exclusive of other cancer syndromes.

    “familial pancreatic cancer is a syndrome that is defined as having multiple first-degree relatives with pancreatic ductal adenocarcinoma, exclusive of other cancer syndromes.36”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [36] Grocock CJ, Vitone LJ, Harcus MJ, Neoptolemos JP, Raraty MG, Greenhalf W. Familial pancreatic cancer: a review and latest advances. Adv Med Sci 2007; 52: 37– 49. 18217388

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    An incidental pancreatic cyst seen on MRI has a 10 in 100,000 chance of being a mucinous invasive malignancy and a 17 in 100,000 chance of being a ductal cancer.

    “It is estimated that a cyst seen incidentally on MRI has a 10 in 100 000 chance of being a mucinous invasive malignancy, and a 17 in 100 000 chance of being a ductal cancer.21”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [21] Vege SS, Ziring B, Jain R, Moayyedi P, Clinical Guidelines Committee, American Gastroenterology Association. American gastroenterological association institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology 2015; 148: 819– 22; quize12–3. 25805375 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Some families affected by BRCA2 mutations have an increased incidence of pancreatic ductal adenocarcinoma and breast or ovarian cancer, and are classified as having both HBOC and hereditary pancreatic cancer.

    “Some families affected by BRCA2 mutations have an increased incidence of pancreatic ductal adenocarcinoma and breast or ovarian cancer. These families are classified as having both HBOC and hereditary pancreatic cancer.33”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [33] Iqbal J, Ragone A, Lubinski J, The incidence of pancreatic cancer in BRCA1 and BRCA2 mutation carriers. Br J Cancer 2012; 107: 2005– 09. 23099806 PMC3516682 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    In the absence of autosomal dominance, an individual's risk of pancreatic ductal adenocarcinoma might be high, but it is difficult or impossible to predict prospectively.

    “In the absence of autosomal dominance, risk for an individual might be high, but such a risk is difficult or impossible to prospectively predict.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    A combined molecular and clinical marker panel was more accurate than current clinical features alone for classifying patients with pancreatic cysts who required surgery, routine monitoring, or no surveillance, and its use would have decreased unnecessary operations by 60% compared with conventional clinical and imaging criteria alone.

    “A study of 862 individuals undergoing surgery for pancreatic cysts found that a combined molecular and clinical marker panel was more accurate than current clinical features alone for classifying patients who required surgery, or routine monitoring, or did not require surveillance; use of these combined markers would have decreased the number of unnecessary operations by 60% compared with the use”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [41] Springer S, Masica DL, Dal Molin M, A multimodality test to guide the management of patients with a pancreatic cyst. Sci Transl Med 2019; 11: eaav4772. 31316009 PMC7859881 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Pancreatic ductal adenocarcinoma has an incidence of 8-12 per 100,000 per year and a lifetime risk of 1.3%.

    “with an incidence of 8–12 per 100 000 per year and a 1·3% lifetime risk of developing the disease.3”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68: 394– 424. 30207593

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    The 5% lifetime-risk target group includes individuals with at least two first-degree relatives with pancreatic ductal adenocarcinoma, patients with hereditary pancreatitis or particular genetic syndromes, and individuals with mucinous cystic lesions of the pancreas.

    “This target includes individuals with at least two first-degree relatives with pancreatic ductal adenocarcinoma, patients with hereditary pancreatitis or particular genetic syndromes (eg, Peutz-Jeghers syndrome, or germline mutations in the CDKN2A, BRCA2, or PALB2),6,54 and individuals with mucinous cystic lesions of the pancreas.19–21”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [6] Canto MI, Harinck F, Hruban RH, International Cancer of the Pancreas Screening (CAPS) Consortium summit on the management of patients with increased risk for familial pancreatic cancer. Gut 2013; 62: 339– 47. 23135763 PMC3585492 source

      Not checked in the free run.

    • cites [54] Kenner BJ, Chari ST, Cleeter DF, Go VL. Early detection of sporadic pancreatic cancer: strategic map for innovation—a white paper. Pancreas 2015; 44: 686– 92. 25938853 PMC4467583 source

      Not checked in the free run.

    • cites [19] Kimura W, Moriya T, Hirai I, Multicenter study of serous cystic neoplasm of the Japan pancreas society. Pancreas 2012; 41: 380– 87. 22415666 source

      Not checked in the free run.

    • cites [20] Del Chiaro M, Verbeke C, Salvia R, European experts consensus statement on cystic tumours of the pancreas. Dig Liver Dis 2013; 45: 703– 11. 23415799 source

      Not checked in the free run.

    • cites [21] Vege SS, Ziring B, Jain R, Moayyedi P, Clinical Guidelines Committee, American Gastroenterology Association. American gastroenterological association institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology 2015; 148: 819– 22; quize12–3. 25805375 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    International guidelines and a white paper on early detection recommend targeted screening of individuals whose lifetime risk of pancreatic ductal adenocarcinoma is higher than 5%.

    “However, international guidelines and a white paper on the early detection of pancreatic ductal adenocarcinoma recommend targeted screening of individuals whose lifetime risk of developing pancreatic ductal adenocarcinoma is higher than 5% (figure 1).6,54”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [6] Canto MI, Harinck F, Hruban RH, International Cancer of the Pancreas Screening (CAPS) Consortium summit on the management of patients with increased risk for familial pancreatic cancer. Gut 2013; 62: 339– 47. 23135763 PMC3585492 source

      Not checked in the free run.

    • cites [54] Kenner BJ, Chari ST, Cleeter DF, Go VL. Early detection of sporadic pancreatic cancer: strategic map for innovation—a white paper. Pancreas 2015; 44: 686– 92. 25938853 PMC4467583 source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Guidelines recommend immediate surgical resection for any pancreatic lesion with high-risk stigmata and regular surveillance with interval imaging for all mucinous or indeterminate lesions.

    “Guidelines recommend immediate surgical resection for any lesion with high-risk stigmata, and regular surveillance with interval imaging (MRI or endoscopic ultrasound) for all mucinous or indeterminate lesions.21,60”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [21] Vege SS, Ziring B, Jain R, Moayyedi P, Clinical Guidelines Committee, American Gastroenterology Association. American gastroenterological association institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology 2015; 148: 819– 22; quize12–3. 25805375 source

      Not checked in the free run.

    • cites [60] European Study Group on Cystic Tumours of the Pancreas. European evidence-based guidelines on pancreatic cystic neoplasms. Gut 2018; 67: 789– 804. 29574408 PMC5890653 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Other high-risk groups for pancreatic ductal adenocarcinoma include individuals with new-onset diabetes, modifiable risk factors, non-modifiable risk factors, specific comorbidities, or early symptoms.

    “Other high-risk groups have been identified, such as individuals with new-onset diabetes (as discussed above), modifiable risk factors (eg, smoking, obesity), non-modifiable risk factors (eg, age), specific comorbidities (eg, obesity, chronic pancreatitis), or early symptoms (some of which are present for more than 1 year before diagnosis).10,12,13,56”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [10] Keane MG, Horsfall L, Rait G, Pereira SP. A case-control study comparing the incidence of early symptoms in pancreatic and biliary tract cancer. BMJ Open 2014; 4: e005720. PMC4244441 25410605 source

      Not checked in the free run.

    • cites [12] Hippisley-Cox J, Coupland C. Identifying patients with suspected pancreatic cancer in primary care: derivation and validation of an algorithm. Br J Gen Pract 2012; 62: e38– 45. 22520674 PMC3252538 source

      Not checked in the free run.

    • cites [13] Stapley S, Peters TJ, Neal RD, Rose PW, Walter FM, Hamilton W. The risk of pancreatic cancer in symptomatic patients in primary care: a large case-control study using electronic records. Br J Cancer 2012; 106: 1940– 44. 22617126 PMC3388562 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    The US Preventive Services Task Force and other guidelines recommend against screening for pancreatic ductal adenocarcinoma in asymptomatic adults at average risk.

    “The US Preventive Services Task Force and other guidelines recommend against screening for pancreatic ductal adenocarcinoma in asymptomatic adults at average risk.6,53,54”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [6] Canto MI, Harinck F, Hruban RH, International Cancer of the Pancreas Screening (CAPS) Consortium summit on the management of patients with increased risk for familial pancreatic cancer. Gut 2013; 62: 339– 47. 23135763 PMC3585492 source

      Not checked in the free run.

    • cites [53] Owens DK, Davidson KW, Krist AH, Screening for pancreatic cancer: US Preventive Services Task Force Reaffirmation Recommendation Statement. JAMA 2019; 322: 438– 44. 31386141 source

      Not checked in the free run.

    • cites [54] Kenner BJ, Chari ST, Cleeter DF, Go VL. Early detection of sporadic pancreatic cancer: strategic map for innovation—a white paper. Pancreas 2015; 44: 686– 92. 25938853 PMC4467583 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Established screening programmes for pancreatic ductal adenocarcinoma include the pan-European EUROPAC registry, the North American National Familial Pancreatic Tumor Registry, and the German National Case Collection for familial pancreatic cancer.

    “Established screening programmes exist, including the pan-European EUROPAC registry,36 North American National Familial Pancreatic Tumor Registry,57 and the German National Case Collection for familial pancreatic cancer.58”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [36] Grocock CJ, Vitone LJ, Harcus MJ, Neoptolemos JP, Raraty MG, Greenhalf W. Familial pancreatic cancer: a review and latest advances. Adv Med Sci 2007; 52: 37– 49. 18217388

      Not checked in the free run.

    • cites [57] Hruban RH, Petersen GM, Goggins M, Familial pancreatic cancer. Ann Oncol 1999; 10 (suppl 4): 69– 73. 10436789 source

      Not checked in the free run.

    • cites [58] Schneider R, Slater EP, Sina M, German national case collection for familial pancreatic cancer (FaPaCa): ten years experience. Fam Cancer 2011; 10: 323– 30. 21207249 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Approximately 8% of all pancreatic ductal adenocarcinomas are believed to arise from premalignant mucinous cystic lesions of the pancreas.

    “Approximately 8% of all pancreatic ductal adenocarcinomas are believed to arise from premalignant mucinous cystic lesions of the pancreas.59”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [59] Le H, Ziogas A, Rhee JM, Lee JG, Lipkin SM, Zell JA. A population-based, descriptive analysis of malignant intraductal papillary mucinous neoplasms of the pancreas. Cancer Epidemiol Biomarkers Prev 2008; 17: 2737– 41. 18843017 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Combining risk factors through cancer decision support tools can reach the 5% risk threshold in some individuals, defining a further group suitable for screening.

    “However, by combining these factors through cancer decision support tools, the 5% risk threshold can be reached in some individuals, defining a further group suitable for screening.10,12,13”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [10] Keane MG, Horsfall L, Rait G, Pereira SP. A case-control study comparing the incidence of early symptoms in pancreatic and biliary tract cancer. BMJ Open 2014; 4: e005720. PMC4244441 25410605 source

      Not checked in the free run.

    • cites [12] Hippisley-Cox J, Coupland C. Identifying patients with suspected pancreatic cancer in primary care: derivation and validation of an algorithm. Br J Gen Pract 2012; 62: e38– 45. 22520674 PMC3252538 source

      Not checked in the free run.

    • cites [13] Stapley S, Peters TJ, Neal RD, Rose PW, Walter FM, Hamilton W. The risk of pancreatic cancer in symptomatic patients in primary care: a large case-control study using electronic records. Br J Cancer 2012; 106: 1940– 44. 22617126 PMC3388562 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Surveillance protocols for pancreatic cysts typically recommend cross-sectional imaging once every 6 months in the first year and annually thereafter if no changes are detected.

    “Surveillance protocols vary between the different guidelines, but typically recommend cross-sectional imaging once every 6 months in the first year, and annually thereafter if no changes are detected.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [21] Vege SS, Ziring B, Jain R, Moayyedi P, Clinical Guidelines Committee, American Gastroenterology Association. American gastroenterological association institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology 2015; 148: 819– 22; quize12–3. 25805375 source

      Not checked in the free run.

    • cites [60] European Study Group on Cystic Tumours of the Pancreas. European evidence-based guidelines on pancreatic cystic neoplasms. Gut 2018; 67: 789– 804. 29574408 PMC5890653 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The diabetes experienced by most patients with pancreatic ductal adenocarcinoma is of recent onset, diagnosed less than 24-36 months before diagnosis, and is improved by surgical resection of the tumour.

    “The diabetes experienced by most patients with pancreatic ductal adenocarcinoma is of recent onset (diagnosed less than 24–36 months before diagnosis of pancreatic ductal adenocarcinoma), and is improved by surgical resection of the tumour.48”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [48] Hart PA, Bellin MD, Andersen DK, Type 3c (pancreatogenic) diabetes mellitus secondary to chronic pancreatitis and pancreatic cancer. Lancet Gastroenterol Hepatol 2016; 1: 226– 37. 28404095 PMC5495015 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Screening the general population for pancreatic ductal adenocarcinoma carries risk, and there is currently no evidence that it reduces mortality or is cost-effective.

    “Screening of the general population carries risk, and there is currently no evidence that it reduces mortality or is cost-effective.54,55”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [54] Kenner BJ, Chari ST, Cleeter DF, Go VL. Early detection of sporadic pancreatic cancer: strategic map for innovation—a white paper. Pancreas 2015; 44: 686– 92. 25938853 PMC4467583 source

      Not checked in the free run.

    • cites [55] Henrikson NB, Aiello Bowles EJ, Blasi PR, Screening for pancreatic cancer: updated evidence report and systematic review for the US preventive services task force. JAMA 2019; 322: 445– 54. 31386140 PMC13387050 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    That study, done within the Swedish health-care system, concluded that biomarker-mediated screening is highly desirable.

    “This study, which was done within the Swedish health-care system, concluded that biomarker-mediated screening is highly desirable.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [74] Ghatnekar O, Andersson R, Svensson M, Modelling the benefits of early diagnosis of pancreatic cancer using a biomarker signature. Int J Cancer 2013; 133: 2392– 97. 23649606 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Patients often show symptoms that suggest pancreatic ductal adenocarcinoma at repeated primary care consultations before diagnosis, but they often encounter delays in the workup process.

    “Although patients often show symptoms that suggest pancreatic ductal adenocarcinoma at repeated primary care consultations before diagnosis,12,13,63 they often encounter delays in the workup process.64”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [12] Hippisley-Cox J, Coupland C. Identifying patients with suspected pancreatic cancer in primary care: derivation and validation of an algorithm. Br J Gen Pract 2012; 62: e38– 45. 22520674 PMC3252538 source

      Not checked in the free run.

    • cites [13] Stapley S, Peters TJ, Neal RD, Rose PW, Walter FM, Hamilton W. The risk of pancreatic cancer in symptomatic patients in primary care: a large case-control study using electronic records. Br J Cancer 2012; 106: 1940– 44. 22617126 PMC3388562 source

      Not checked in the free run.

    • cites [63] Lyratzopoulos G, Neal RD, Barbiere JM, Rubin GP, Abel GA. Variation in number of general practitioner consultations before hospital referral for cancer: findings from the 2010 National Cancer Patient Experience Survey in England. Lancet Oncol 2012; 13: 353– 65. 22365494 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In 2013, cancer decision support tools were incorporated into software systems of general practitioner practices in the UK.

    “In 2013, cancer decision support tools were incorporated into software systems of general practitioner practices in the UK.12”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] Hippisley-Cox J, Coupland C. Identifying patients with suspected pancreatic cancer in primary care: derivation and validation of an algorithm. Br J Gen Pract 2012; 62: e38– 45. 22520674 PMC3252538 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationnone given

    Biomarkers could play an important role in early detection of pancreatic ductal adenocarcinoma by enriching for individuals in high-risk groups who have the highest chance of a cancer diagnosis, thereby helping clinicians prioritise individuals for screening.

    “Biomarkers could play an important role in early detection of pancreatic ductal adenocarcinoma by enriching for individuals in high-risk groups who have the highest chance of a cancer diagnosis, thereby helping clinicians prioritise individuals for screening (figure 2).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Because normal-tissue signals are reduced or removed, synthetic biomarker signals can be made highly cancer-specific and tailored for sensitive detection.

    “Because signals from normal tissues are reduced or eliminated, the signals can be engineered to be highly specific for cancer, and the method can be tailored for highly sensitive detection tools.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    More frequent surveillance is advocated for larger pancreatic lesions or lesions with worrisome features.

    “More frequent surveillance is advocated for larger lesions or lesions with worrisome features.21,60”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [21] Vege SS, Ziring B, Jain R, Moayyedi P, Clinical Guidelines Committee, American Gastroenterology Association. American gastroenterological association institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology 2015; 148: 819– 22; quize12–3. 25805375 source

      Not checked in the free run.

    • cites [60] European Study Group on Cystic Tumours of the Pancreas. European evidence-based guidelines on pancreatic cystic neoplasms. Gut 2018; 67: 789– 804. 29574408 PMC5890653 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The use of high-risk groups as controls and combining molecular markers with clinical features is an important consideration when identifying biomarkers capable of selecting populations at highest risk of pancreatic ductal adenocarcinoma for screening.

    “Moreover, the use of high-risk groups as controls and combining molecular markers with clinical features is an important consideration when identifying biomarkers capable of selecting populations at highest risk of development of pancreatic ductal adenocarcinoma for screening.75”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [75] Springer S, Wang Y, Dal Molin M, A combination of molecular markers and clinical features improve the classification of pancreatic cysts. Gastroenterology 2015; 149: 1501– 10. 26253305 PMC4782782 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Research into the molecular changes occurring during progression from precursor lesion through early-stage pancreatic ductal adenocarcinoma to advanced disease is generating greater understanding and providing a basis for rational biomarker development strategies.

    “Research into the molecular changes occurring during the sequential progression from lesion, through early-stage pancreatic ductal adenocarcinoma, and finally to advanced disease is generating a greater understanding of development and progression of pancreatic ductal adenocarcinoma. This understanding is providing a basis for designing rational strategies to develop biomarkers for early detection”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Single biomarkers will probably not have high sensitivity for detection of pancreatic ductal adenocarcinoma, and robust panels of biomarkers will be required.

    “Consequently, single biomarkers will probably not have high sensitivity for detection of pancreatic ductal adenocarcinoma, and robust panels of biomarkers will be required.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Studies underway in the USA and UK are actively investigating how best to detect pancreatic ductal adenocarcinoma in individuals with new-onset diabetes.

    “However, studies underway in the USA61 and UK62 are actively investigating how best to detect pancreatic ductal adenocarcinoma in individuals with new-onset diabetes.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [61] Maitra A, Sharma A, Brand RE, A prospective study to establish a new-onset diabetes cohort: from the consortium for the study of chronic pancreatitis, diabetes, and pancreatic cancer. Pancreas 2018; 47: 1244– 48. 30325864 PMC6432934 source

      Not checked in the free run.

    • cites [62] UK Early Detection Initiative, Liverpool Clinical Trials Centre, Cancer Research UK. UK early detection initiative for pancreatic cancer. www.uk-edi.co.uk (accessed Sept 17, 2019).

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The usefulness and outcomes of the current UK programme are subject to ongoing assessment via the Accelerate, Coordinate, Evaluate Programme.

    “The usefulness and outcomes of the current programme are subject to ongoing assessment via the Accelerate, Coordinate, Evaluate Programme, an initiative supported by Cancer Research UK and Macmillan Cancer Support.65”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [65] Cancer Research UK. Accelerate, Coordinate, Evaluate (ACE) programme. 2019 https://www.cancerresearchuk.org/health-professional/diagnosis/accelerate-coordinate-evaluate-ace-programme/multidisciplinary-diagnostic-centres-mdcs (accessed Sept 2, 2019).

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    Large population-based cohorts such as UKCTOCS and EPIC contain patient samples that precede diagnosis of pancreatic ductal adenocarcinoma, but crucial information such as family history and comorbidity data are not consistently available.

    “Although large population-based cohorts that have recruited healthy individuals (such as UKCTOCS72 and EPIC73) contain patient samples that precede diagnosis of pancreatic ductal adenocarcinoma, crucial information—such as family history and comorbidity data, including the presence of chronic pancreatitis or diabetes—are not consistently available.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [72] Menon U, Gentry-Maharaj A, Ryan A, Recruitment to multicentre trials—lessons from UKCTOCS: descriptive study. BMJ 2008; 337: a2079. 19008269 PMC2583394 source

      Not checked in the free run.

    • cites [73] Riboli E, Hunt KJ, Slimani N, European Prospective Investigation into Cancer and Nutrition (EPIC): study populations and data collection. Public Health Nutr 2002; 5: 1113– 24. 12639222 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    A small pilot study suggested that pancreatic ductal adenocarcinoma-associated diabetes may be distinguished from type 2 diabetes by a blunted pancreatic polypeptide response to a mixed meal.

    “A small pilot study suggested that pancreatic ductal adenocarcinoma-associated diabetes might be distinguished from the more prevalent type 2 diabetes by a blunted pancreatic polypeptide response to a mixed meal.94”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [94] Hart PA, Baichoo E, Bi Y, Hinton A, Kudva YC, Chari ST. Pancreatic polypeptide response to a mixed meal is blunted in pancreatic head cancer associated with diabetes mellitus. Pancreatology 2015; 15: 162– 66. 25766398 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    An artificial neural network model using US National Health Interview Survey and PLCO Trial data reached an AUC of 0.85 and included age, sex, race and ethnicity, diabetes, emphysema, asthma, stroke, cardiovascular diseases, ulcers, other cancer, hypertension, smoking status, physical activity, alcohol consumption, and family history of pancreatic ductal adenocarcinoma.

    “This model reached an AUC of 0·85 and incorporated data on age, sex, race and ethnicity, diabetes, emphysema, asthma, stroke, cardiovascular diseases, ulcers, other cancer, hypertension, smoking status, physical activity, alcohol consumption, and family history of pancreatic ductal adenocarcinoma.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [109] Muhammad W, Hart GR, Nartowt B, Pancreatic cancer prediction through an artificial neural network. Front Artif Intell 2019; 2: 2. PMC7861334 33733091 source

      Not checked in the free run.

    • cites [110] Klein AP, Lindström S, Mendelsohn JB, An absolute risk model to identify individuals at elevated risk for pancreatic cancer in the general population. PLoS One 2013; 8: e72311. 24058443 PMC3772857 source

      Not checked in the free run.

    • cites [111] Risch HA, Yu H, Lu L, Kidd MS. Detectable symptomatology preceding the diagnosis of pancreatic cancer and absolute risk of pancreatic cancer diagnosis. Am J Epidemiol 2015; 182: 26– 34. 26049860 PMC4479115 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Other research-interview models have not matched that performance but consistently show that age, sex, smoking, diabetes, family history of pancreatic ductal adenocarcinoma, abdominal symptoms, and blood group indicate increased risk.

    “Other models based on research interviews have not reached similar levels of performance, but have consistently shown that age, sex, smoking, diabetes, family history of pancreatic ductal adenocarcinoma, abdominal symptoms, and blood group point to an increased risk of pancreatic ductal adenocarcinoma.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Sarcopenia and fat loss are known components of the wasting syndrome of pancreatic ductal adenocarcinoma and may have prognostic implications.

    “Indeed, sarcopenia and fat loss are known to be part of a wasting syndrome of pancreatic ductal adenocarcinoma and might have prognostic implications.117,118”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [117] Ozola Zalite I, Zykus R, Francisco Gonzalez M, Influence of cachexia and sarcopenia on survival in pancreatic ductal adenocarcinoma: a systematic review. Pancreatology 2015; 15: 19– 24. 25524484 source

      Not checked in the free run.

    • cites [118] Peng P, Hyder O, Firoozmand A, Impact of sarcopenia on outcomes following resection of pancreatic adenocarcinoma. J Gastrointest Surg 2012; 16: 1478– 86. 22692586 PMC3578313 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Electronic health record models consistently have high specificity and low sensitivity, leading to high false-negative rates.

    “A consistent performance characteristic of electronic health record models is high specificity and low sensitivity, leading to high false-negative rates.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Further insurance-claim models have been developed and have poor diagnostic performance (AUC 0.73).

    “Further models based on insurance claims have been developed, with poor diagnostic performance (AUC 0·73).106,107”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [106] Baecker A, Kim S, Risch HA, Do changes in health reveal the possibility of undiagnosed pancreatic cancer? Development of a risk-prediction model based on healthcare claims data. PLoS One 2019; 14: e0218580. 31237889 PMC6592596 source

      Not checked in the free run.

    • cites [107] Hsieh MH, Sun LM, Lin CL, Hsieh MJ, Hsu CY, Kao CH. Development of a prediction model for pancreatic cancer in patients with type 2 diabetes using logistic regression and artificial neural network models. Cancer Manag Res 2018; 10: 6317– 24. 30568493 PMC6267763 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The same UK model applied to people with pre-diabetes had lower accuracy (AUC 0.71) but a consistent direction of association with pancreatic ductal adenocarcinoma.

    “The same model applied to individuals with pre-diabetes showed lower accuracy (AUC 0·71), but consistent direction of association with pancreatic ductal adenocarcinoma.105”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [105] Boursi B, Finkelman B, Giantonio BJ, A clinical prediction model to assess risk for pancreatic cancer among patients with new-onset diabetes. Gastroenterology 2017; 152: 840– 50.e3. 27923728 PMC5337138 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Non-invasive measurement of body compartments has been fully automated and applied to pancreatic ductal adenocarcinoma through artificial intelligence, and could be incorporated into routine diagnostic imaging.

    “The non-invasive measurement of different body compartments has already been fully automated and applied to pancreatic ductal adenocarcinoma through artificial intelligence methodologies, and this application could be easily incorporated into the evaluation of routine diagnostic imaging.119”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [119] Bridge CP, Rosenthal M, Wright B, Fully-automated analysis of body composition from CT in cancer patients using convolutional neural networks. International workshop on skin image analysis; 10 2, 2018. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A South Korean time-to-event model using routine health examination data performed as well as the UK model (AUC 0.81) but had low positive predictive value (0.3-0.4% risk over 10 years) because it was evaluated in the general unselected population aged 40 years and older.

    “This model performed as well (AUC=0·81) as the UK model,105 but had low positive predictive value (0·3–0·4% risk over 10 years) because it was evaluated in the general unselected population aged 40 years and older.108”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [108] Yu A, Woo SM, Joo J, Development and validation of a prediction model to estimate individual risk of pancreatic cancer. PLoS One 2016; 11: e0146473. 26752291 PMC4708985 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationnone given

    Identifying the few individuals with mucinous cystic lesions who are at highest risk of progression to pancreatic ductal adenocarcinoma remains a key knowledge gap.

    “With respect to mucinous cysts, identifying the few individuals with mucinous cystic lesions at the highest risk of progression to pancreatic ductal adenocarcinoma is still a key knowledge gap.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationnone given

    Careful and ethical use of existing social media or electronic health record data can facilitate prediction models.

    “Careful and ethical use of existing data—whether through social media or electronic health records—has the power to facilitate prediction models, whereas artificial intelligence applied to imaging offers the possibility of detecting earlier lesions.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given

    Advances in early detection will accompany improvements in treatment to extend survival for people with pancreatic ductal adenocarcinoma.

    “Advances in early detection will go together with improvements in treatment to extend survival for people with pancreatic ductal adenocarcinoma.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Muhammad and colleagues used artificial intelligence to analyse personal health data to calculate pancreatic ductal adenocarcinoma risk in the general population and identify high-risk individuals.

    “Muhammad and colleagues used artificial intelligence to analyse available personal health data to calculate risk for pancreatic ductal adenocarcinoma in the general population and to identify high-risk individuals.109”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [109] Muhammad W, Hart GR, Nartowt B, Pancreatic cancer prediction through an artificial neural network. Front Artif Intell 2019; 2: 2. PMC7861334 33733091 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Roffman and colleagues used artificial intelligence to predict non-melanoma skin cancer from personal health data commonly available in electronic medical records.

    “Roffman and colleagues127 used artificial intelligence to predict non-melanoma skin cancer by using personal health data (eg, sex, race, Hispanic ethnicity, hypertension, heart disease, exercise habits, history of stroke) commonly available in electronic medical record systems.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [127] Roffman D, Hart G, Girardi M, Ko CJ, Deng J. Predicting non-melanoma skin cancer via a multi-parameterized artificial neural network. Sci Rep 2018; 8: 1701. 29374196 PMC5786038

      Not checked in the free run.

49 of 49

  • The paper relies on this without support.

    In some cases, the definitive diagnosis of pancreatic ductal adenocarcinoma is only possible after surgery, when sufficient tumour material is available for histological diagnosis.

    “In some cases, the definitive diagnosis of pancreatic ductal adenocarcinoma is only possible following surgery (when there is sufficient tumour material to make the histological diagnosis), which carries the risk of substantial morbidity and mortality.”

  • The paper relies on this without support.

    Some hereditary cancer syndromes, including HBOC, Lynch syndrome 2, FAMMM, Peutz-Jegher’s syndrome, and Li-Fraumeni syndrome, are associated with pancreatic ductal adenocarcinoma.

    “Some hereditary cancer syndromes—including hereditary breast-ovarian cancer syndrome (HBOC), Lynch syndrome 2, familial atypical multiple mole melanoma (FAMMM), Peutz-Jegher’s syndrome, and Li-Fraumeni syndrome—are associated with pancreatic ductal adenocarcinoma.”

  • The paper relies on this without support.

    Not all pancreatic cystic lesions are intraductal papillary mucinous neoplasms or mucinous cystic neoplasms; many have no risk of malignant transformation and do not require surveillance.

    “First, not all pancreatic cystic lesions are intraductal papillary mucinous neoplasms and mucinous cystic neoplasms. Many are cystic lesions with no risk of malignant transformation and thus do not require surveillance.”

  • The paper relies on this without support.

    Most intraductal papillary mucinous neoplasms and mucinous cystic neoplasms do not progress to pancreatic ductal adenocarcinoma.

    “Second, most intraductal papillary mucinous neoplasms and mucinous cystic neoplasms do not progress to pancreatic ductal adenocarcinoma.”

  • The paper relies on this without support.

    Currently available clinical tools are imperfect at differentiating benign pancreatic cysts that are safe to discharge, mucinous cystic lesions that harbour high-grade dysplasia or pancreatic ductal adenocarcinoma and require surgical resection, and mucinous cystic lesions with low-grade dysplasia that are safe to watch.

    “Currently available clinical tools are imperfect at differentiating between benign cysts that are safe to discharge, mucinous cystic lesions that harbour high-grade dysplasia or pancreatic ductal adenocarcinoma and require surgical resection, and mucinous cystic lesions that have low-grade dysplasia and are safe to watch.”

  • The paper relies on this without support.

    Different types of pancreatic cysts have specific mutational profiles that can be used to identify the type of cyst with a high level of confidence.

    “We now know that different types of pancreatic cysts have specific mutational profiles that can be used to identify the type of cysts with a high level of confidence.”

  • The paper relies on this without support.

    People with long-standing type 2 diabetes of more than 5 years have a 1–1.5-fold increased risk of pancreatic ductal adenocarcinoma compared with the general population.

    “People with long-standing type 2 diabetes (more than 5 years) have a 1–1·5-fold increased risk of pancreatic ductal adenocarcinoma compared with the general population.”

  • The paper relies on this without support.

    Individuals with new-onset diabetes are the highest risk group for sporadic pancreatic ductal adenocarcinoma.

    “and individuals with new-onset diabetes are the highest risk group for sporadic pancreatic ductal adenocarcinoma.”

  • The paper relies on this without support.

    Approximately 0.8–1% of individuals aged over 50 years with new-onset diabetes have diabetes secondary to pancreatic ductal adenocarcinoma.

    “Approximately 0·8–1% of individuals aged over 50 years with new-onset diabetes have diabetes secondary to pancreatic ductal adenocarcinoma.”

  • The paper relies on this without support.

    For newly identified high-risk groups such as patients with new-onset diabetes, there are no established guidelines or screening programmes.

    “For the newly identified high-risk groups (such as patients with new-onset diabetes), there are no established guidelines or screening programmes.”

  • The paper relies on this without support.

    Despite thousands of published papers, no single candidate biomarker has translated to clinical use for the early detection of pancreatic ductal adenocarcinoma.

    “However, despite thousands of published papers, no single candidate biomarker has translated to clinical use for the early detection of pancreatic ductal adenocarcinoma.”

  • The paper relies on this without support.

    The low incidence of pancreatic ductal adenocarcinoma makes acquiring the quantity of samples necessary for biomarker development difficult, requiring large national and international collaborations.

    “The low incidence of pancreatic ductal adenocarcinoma means that acquiring the quantity of samples necessary for biomarker development is not easy, and large national and international collaborations are required.”

  • The paper relies on this without support.

    Currently, biomarker studies do not account well for the finding that a high proportion of patients with pancreatic ductal adenocarcinoma have diabetes, so emerging biomarkers could have an association with diabetes rather than with pancreatic ductal adenocarcinoma.

    “Currently, biomarker studies do not account well for the finding that a high proportion of patients with pancreatic ductal adenocarcinoma have diabetes;50 thus, emerging biomarkers could have an association with diabetes rather than with pancreatic ductal adenocarcinoma.”

  • The paper relies on this without support.

    A pronounced deficit in early detection studies for pancreatic ductal adenocarcinoma has been the absence of bespoke pre-diagnostic cohorts.

    “Finally, a pronounced deficit in early detection studies for pancreatic ductal adenocarcinoma has been the absence of bespoke pre-diagnostic cohorts.”

  • The paper relies on this without support.

    No biomarkers are currently validated for early detection of pancreatic ductal adenocarcinoma.

    “Currently, there are no biomarkers validated for early detection of pancreatic ductal adenocarcinoma.”

  • The paper relies on this without support.

    CA19-9 is elevated in benign and malignant diseases other than pancreatic ductal adenocarcinoma.

    “and the marker is increased in other benign and malignant diseases.”

  • The paper relies on this without support.

    CA19-9 is not expressed in people with a Lewis-negative genotype.

    “CA19–9 is not expressed in individuals with a Lewis-negative genotype”

  • The paper relies on this without support.

    Onset of diabetes after age 50 is the best available clinical marker for early detection of pancreatic ductal adenocarcinoma.

    “Onset of diabetes after age 50 was chosen as the best clinical marker available for early detection of pancreatic ductal adenocarcinoma”

  • The paper relies on this without support.

    Patients with pancreatic ductal adenocarcinoma first experience subtle, vague symptoms that can precede diagnosis by years.

    “Because patients with pancreatic ductal adenocarcinoma first experience subtle, vague symptoms that can precede the diagnosis by years”

  • The paper relies on this without support.

    Visual assessment by imaging physicians is qualitative, subjective, and prone to errors and intra-observer and inter-observer variability.

    “However, visual assessment by imaging physicians is qualitative, subjective, and prone to errors and intra-observer and inter-observer variabilities.”

  • The paper relies on this without support.

    Many distinguishing features of medical images are hidden from human observers.

    “More importantly, many distinguishing features of images are hidden from human observers.”
21 of 21

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Current pancreatic cancer biomarkers lack sufficient sensitivity and specificity for clinical application.

    “However, the current PC biomarkers lack sufficient sensitivity and specificity for clinical application 44,161,170.”

    From Artificial intelligence in pancreatic cancer (2022) · cites this paper as [44]

    The ‘Challenges and opportunities’ section says no candidate biomarker has entered clinical use for early detection and that single biomarkers will probably lack high sensitivity. ‘Current promising biomarkers for early detection’ also describes limitations of CA19-9 that undermine its use for screening. The claim is broader than the paper’s conclusion: the paper says CA19-9 is routinely used in pancreatic cancer management, so it does not support a lack of suitability for all clinical applications. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • Disease controls such as chronic pancreatitis are needed in biomarker studies because some biomarkers are present in both chronic pancreatitis and PDAC.

    “Of note, the literature addresses the fact that disease controls such as chronic pancreatitis are needed in studies as there are several examples of biomarkers present in both chronic pancreatitis and PDAC.178”

    From Artificial Intelligence and Early Detection of Pancreatic Cancer: 2020 Summative Review (2021) · cites this paper as [178]

    The ‘Challenges and opportunities’ section says biomarker studies incorporate disease controls such as chronic pancreatitis to account for confounding. The ‘Current promising biomarkers’ section notes that CA19-9 can be elevated in benign diseases, but our copy does not give several examples of biomarkers present in both chronic pancreatitis and PDAC. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Chronic pancreatitis, especially in those who develop diabetes with chronic pancreatitis, has the highest proportional risk of developing PDAC.

    “For example, chronic pancreatitis especially those who develop diabetes with chronic pancreatitis have the highest proportional risk of developing PDAC.178,179”

    From Artificial Intelligence and Early Detection of Pancreatic Cancer: 2020 Summative Review (2021) · cites this paper as [178]

    The 'Who should be screened?' section identifies chronic pancreatitis as a comorbidity in a high-risk group for pancreatic ductal adenocarcinoma. But the 'New-onset diabetes mellitus' section calls people with new-onset diabetes the highest-risk group for sporadic disease; it does not say that people who develop diabetes with chronic pancreatitis have the highest proportional risk. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Patients increasingly identified with pancreatic cysts are another risk population for PDAC.

    “Another risk population are those patients who are increasingly identified with pancreatic cysts.178”

    From Artificial Intelligence and Early Detection of Pancreatic Cancer: 2020 Summative Review (2021) · cites this paper as [178]

    The “High-risk groups > Cystic lesions” section identifies certain pancreatic cysts as precursors to pancreatic ductal adenocarcinoma and says cysts are often detected incidentally. It also says many cysts have no risk of malignant transformation, and it does not establish that cysts are being identified increasingly over time. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Prediagnostic CT images provide critical morphological information associated with biological changes at the pre-cancer or early cancer stage, which can be extracted using AI and ML methods to predict PDAC.

    “These prediagnostic CT images provide critical morphological information associated with biological changes at the pre-cancer or early cancer stage, which can be extracted using AI and ML methods to predict PDAC.178”

    From Artificial Intelligence and Early Detection of Pancreatic Cancer: 2020 Summative Review (2021) · cites this paper as [178]

    The section “Artificial intelligence-assisted CT methods and novel MRI methods” (page not available) says imaging can reveal morphological and biological changes, including precancerous changes in high-risk individuals. It also says deep learning *might* identify features in prediagnostic images to predict PDAC in the near future; the claim presents that predictive capability as already available. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • One cited model does not fit the stated sensitivity pattern

    Minor

    The paper describes high specificity and low sensitivity as a consistent characteristic of electronic-health-record models, but its Minnesota example reports 78% sensitivity and 80% specificity. That example does not have low sensitivity relative to its specificity.

  • The diabetes-model citations are reversed

    Minor

    The paragraph assigns reference 104 to the new-onset diabetes model and reference 105 to its application in pre-diabetes. The reference list identifies 104 as the pre-diabetes model and 105 as the new-onset diabetes model.

2 of 2

Cites

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2 of the 127 references couldn’t be matched to a known paper.

Cited by

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Related

Authors
Pereira, S. P., Oldfield, L., Ney, A., Hart, P. A., Keane, M. G., Pandol, S. J., Li, D., Greenhalf, W., Jeon, C. Y., Koay, E. J., Almario, C. V., Halloran, C., Lennon, A. M., & Costello, E.
Affiliations
  • University College London (GB)
  • University of Liverpool (GB)
  • The Ohio State University Wexner Medical Center (US)
  • Johns Hopkins University (US)
  • Cedars-Sinai Medical Center (US)
  • The University of Texas MD Anderson Cancer Center (US)
Corresponding author
Costello, Eithne
ORCID
Venue
The Lancet Gastroenterology & Hepatology
Publisher
Elsevier BV
Published
2020-07
Volume
5
Issue
7
Pages
698-710
ISSN
  • 2468-1156 (ISSN-L)
  • 2468-1253
DOI
10.1016/s2468-1253(19)30416-9
PMC
PMC7380506
OpenAlex
W2304258614
Semantic Scholar
dbdbc71bbd1a6d8362bfb5f28c2ceb4a79e97871
Cited by
482
References
127
Citations by year
2026: 47 · 2025: 76 · 2024: 88 · 2023: 89 · 2022: 99 · 2021: 61 · 2020: 22
FWCI
7.28
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet. Gastroenterology & hepatology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • UCL Discovery (University College London) (submittedVersion)
Funders
  • National Center for Advancing Translational Sciences (U01CA196403–01, 1R01CA218004–01A1, 1U01CA200468–01, UL1TR001881–01, U54CA210181–01)
  • Royal College of Surgeons of Edinburgh
  • Pancreatic Cancer Action
  • Cancer Research UK (C52547/A28210, C7690/A26881)
  • National Institute of Diabetes and Digestive and Kidney Diseases (U01DK108327, R01CA230442, U01DK108314, R21CA220073)
  • National Institutes of Health (P50-CA062924)
  • National Cancer Institute
  • Pancreatic Cancer Research Fund
  • Pancreatic Cancer UK
  • National Institute for Health Research
  • National Pancreas Foundation
  • Pancreatic Cancer Action Network
  • Lustgarten Foundation
  • Atlanta Clinical and Translational Science Institute
  • Department of Health, Australian Government
  • North West Cancer Research Fund
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 ductal adenocarcinoma, early detection, high-risk groups, genetic susceptibility, pancreatic cysts, new-onset diabetes, early diagnosis biomarkers, social media, prediction model, electronic health records, artificial intelligence, diagnostic imaging
MeSH terms
Deep Learning, Adult, Aged, Aged, 80 and over, Artificial Intelligence, Diabetes Mellitus, Type 2, Diagnostic Imaging, Female, Humans, Male, Mass Screening, Middle Aged, Pancreatic Cyst, Pancreatic Neoplasms, Risk Factors, Biomarkers, Tumor, Genetic Predisposition to Disease, Carcinoma, Pancreatic Ductal, Early Detection of Cancer, Electronic Health Records, Social Media

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-06.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-06.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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