Early Detection of Pancreatic Cancer: Opportunities and Challenges

Singhi, Aatur D.; Koay, Eugene J.; Chari, Suresh T.; Maitra, Anirban

doi:10.1053/j.gastro.2019.01.259

Cited by 841Pancreatic and Hepatic Oncology ResearchPancreatitis Pathology and TreatmentMRI in cancer diagnosis

Early Detection of Pancreatic Cancer: Opportunities and Challenges

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Singhi, Aatur D., Koay, Eugene J., Chari, Suresh T., Maitra, Anirban·2019·Gastroenterology

DOI 10.1053/j.gastro.2019.01.259PMC PMC6486851

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Abstract

Most patients with pancreatic ductal adenocarcinoma (PDAC) present with symptomatic, surgically unresectable disease. Although the goal of early detection of PDAC is laudable and likely to result in significant improvement in overall survival, the relatively low prevalence of PDAC renders general population screening infeasible. The challenges of early detection include identification of at-risk individuals in the general population who would benefit from longitudinal surveillance programs and appropriate biomarker and imaging-based modalities used for PDAC surveillance in such cohorts. In recent years, various subgroups at higher-than-average risk for PDAC have been identified, including those with familial risk due to germline mutations, a history of pancreatitis, patients with mucinous pancreatic cysts, and elderly patients with new-onset diabetes. The last 2 categories are discussed at length in terms of the opportunities and challenges they present for PDAC early detection. We also discuss current and emerging imaging modalities that are critical to identifying early, potentially curable PDAC in high-risk cohorts on surveillance.

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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 [170]
The Overview (page unavailable) says that biomarkers meeting the performance requirements for use in asymptomatic screening are not yet available. The Road Ahead (page unavailable) says circulating tumor cell and tumor DNA assays cannot be used for screening or early diagnosis because of limited sensitivity, despite high specificity. The claim extends these screening-specific limitations to all clinical applications and implies both measures are insufficient for current biomarkers generally. (LLM, conf=0.83)
Experimental — accuracy not yet measured
Approximately 85-90% of PDAC cases are ascribed to arise from PanIN lesions, with the remaining 10-15% from cystic precursors.
“Approximately 85–90% of PDAC cases are ascribed to originate on the backdrop of PanIN lesions, the remaining 10–15% in cystic precursors20.”
From Pancreatic cancer: Advances and challenges (2023) · cites this paper as [20]

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“CT that is appropriate for the diagnosis of pancreatic cancer should be taken in the arterial phase (approximately 30 s after contrast injection) and portal venous phase (approximately 60–70 s after contrast injection), which are based on the pancreatic protocol (26).”

Authors: Singhi, A. D., Koay, E. J., Chari, S. T., & Maitra, A.
Affiliations: University of Pittsburgh Medical Center (US)
The University of Texas MD Anderson Cancer Center (US)
Mayo Clinic (US)
Corresponding author: Chari, Suresh T.
ORCID: Singhi, Aatur D.
Koay, Eugene J.
Chari, Suresh T.
Maitra, Anirban
Venue: Gastroenterology
Publisher: Elsevier BV
Published: 2019-05
Volume: 156
Issue: 7
Pages: 2024-2040
ISSN: 0016-5085 (ISSN-L)
DOI: 10.1053/j.gastro.2019.01.259
PMC: PMC6486851
OpenAlex: W2913413342
Cited by: 841
References: 185
Citations by year: 2026: 92 · 2025: 150 · 2024: 135 · 2023: 134 · 2022: 120 · 2021: 111 · 2020: 78 · 2019: 20
FWCI: 8.09
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: cc-by-nc-nd
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
creativecommons.org/licenses/by-nc-nd/4.0/ (vor)
Locations: Gastroenterology (publishedVersion, cc-by-nc-nd)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: National Cancer Institute (U01 CA196403, R01 CA218004, U01 CA200468)
National Institutes of Health (DK108288)
GE Healthcare
Pancreatic Cancer Action Network
Mayo Foundation for Medical Education and Research
Topics: Health Sciences › Medicine › Oncology › Pancreatic and Hepatic Oncology Research
Health Sciences › Medicine › Surgery › Pancreatitis Pathology and Treatment
Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › MRI in cancer diagnosis
Keywords: pancreatic ductal adenocarcinoma, early detection, cancer surveillance, vulnerable populations, familial pancreatic cancer, germline mutations, pancreatitis, mucinous pancreatic cysts, new-onset diabetes, pancreatic imaging, biomarkers
MeSH terms: Animals, Diagnostic Imaging, Humans, Pancreatic Neoplasms, Precancerous Conditions, Predictive Value of Tests, Risk Factors, Biomarkers, Tumor, Incidence, Risk Assessment, Carcinoma, Pancreatic Ductal, Early Detection of Cancer, Molecular Imaging

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Early Detection of Pancreatic Cancer: Opportunities and Challenges

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