Screening for pancreatic cancer is confined to defined high-risk groups. The disease is uncommon in the general population, so testing everyone would not be cost-effective and would generate many false alarms.
The vast majority of pancreatic cancers are sporadic, meaning they occur without a strong family pattern. About 5–10% of cases are associated with familial pancreatic cancer, which is defined by a family history of pancreatic cancer in 2 or more first-degree relatives.
The problem with screening is the combination of a low incidence and a costly, expert-dependent test: because the disease is rare even among people with some family history, the cost-effectiveness of wide screening is unfavourable. The high-risk population therefore has to be identified first. The groups offered screening are:
- people with at least 3 blood relatives with pancreatic cancer and at least one first-degree relative with pancreatic cancer;
- people with 2 or more first-degree relatives with pancreatic cancer;
- people with a BRCA2, PALB2 or p16 mutation, or with Lynch syndrome, who also have a first-degree relative with pancreatic cancer;
- people with Peutz-Jeghers syndrome, regardless of family history.
The modality of choice for screening in this high-risk population is MRI/MRCP, which images the pancreas and its ducts and does not expose the patient to the radiation of repeated CT.