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What is pancreatic cancer surveillance?

Surveillance means watching for cancer. Pancreatic cancer surveillance looks for cancer in people at higher risk for getting this type of cancer. This includes yearly imaging tests that look at the pancreas. These tests help find abnormalities in the pancreas very early. Often, when someone shows symptoms of pancreatic cancer, the tumor has progressed to a later stage. When pancreatic cancer is diagnosed early, it is easier to treat and patients may have better outcomes.

Who should get pancreatic cancer surveillance?

Pancreatic cancer surveillance is not recommended for most people in the general population because the average risk of getting pancreatic cancer is low. But some people have a higher risk of getting this type of cancer because of their personal history, family history, genetic factors, or a combination of reasons.

National guidelines recommend pancreatic cancer surveillance for people who fall into any of these categories:

1. People with an increased risk due to these genetic conditions:
   
   • Peutz-Jegher Syndrome (with mutations in STK11 gene)
   • CDKN2A mutations
   • BRCA2 and ATM gene mutations, regardless of family history; screening should begin at age 50
2. People with an increased risk due to a combination of genetic factors and family history:
   
   • Lynch Syndrome (those with mutations in MLH1, MSH2, MSH6 genes only) AND a family history that includes at least one close relative* with exocrine pancreatic cancer
   • Li-Fraumeni Syndrome (those with mutations in TP53 gene) AND a family history that includes at least one close relative* with exocrine pancreatic cancer
   • Hereditary breast and ovarian cancer syndrome (those with mutations in BRCA1/BRCA2 genes) AND a family history that includes at least one close relative* with exocrine pancreatic cancer
   • ATM mutations AND a family history that includes at least one close relative* with exocrine pancreatic cancer
   • PALB2 mutations AND a family history that includes at least one close relative* with exocrine pancreatic cancer
3. People with an increased risk due to family history:
   
   • At least one first-degree relative (parent, sibling, or child) with a history of exocrine pancreatic cancer AND that relative also has a first-degree relative with a history of exocrine pancreatic cancer
4. People with hereditary pancreatitis (mutations in PRSS1, CFTR, SPINK1, CPA1, CTRC) AND a personal history of pancreatitis

*Close relatives include parents, siblings, children, grandparents, aunts, uncles, nieces, and nephews

How is pancreatic cancer surveillance done?

Current national and international guidelines recommend people who undergo pancreatic cancer surveillance get yearly imaging with MRI/magnetic retrograde cholangiopancreatography (MRCP) and/or endoscopic ultrasound (EUS) and that this surveillance should be performed at experienced, high-volume centers, ideally under research conditions.

What age does pancreatic cancer surveillance begin?

The age to begin pancreatic cancer surveillance depends on which category above the person fits into.

• Category 1: Begin surveillance at age 40.
• Categories 2 and 3: Begin at age 45–50.

For anyone with a family member diagnosed with pancreatic cancer at a young age, we offer surveillance starting ten years before the age of their relative’s diagnosis.

• Category 4: Begin at age 40 or twenty years after the first experience with pancreatitis, whichever is earliest.

If you’re not sure whether you should get pancreatic cancer surveillance, call the Family Cancer Assessment Clinic at 801-587-9555.