Screening for pancreatic cancer

This section covers the following topics:

• Types of pancreatic cancer screening
• Pancreatic cancer screening guidelines for high risk people

Experts do not recommend screening healthy people at average risk for pancreatic cancer. In people at high for pancreatic cancer, screening is only recommended for certain people. 

Types of pancreatic cancer screening

• Contrast-enhanced magnetic resonance cholangiopancreatography (MRCP) is a special type of MRI imaging that looks closely at the pancreas, liver, gallbladder, bile duct and pancreatic duct to find abnormalities such as cancer. People undergoing MRCP must fast for four hours before the procedure. An injection of contrast agent—called gadolinium—is given before the test in order to help radiologists to find abnormalities more easily.
• Endoscopic ultrasound (EUS) involves passing a tiny scope with an attached ultrasound probe down the esophagus to the stomach. This allows doctors to look closely at the pancreas. EUS is performed as an outpatient procedure under anesthesia. 

Endoscopic ultrasound procedure to look for pancreatic tumors

Screening for people with inherited mutations

National Comprehensive Cancer Network (NCCN) Guidelines

NCCN recommends that people undergoing pancreatic screening have the procedure at a facility with experience screening people at high risk for pancreatic cancer. Before undergoing screening, people should have a conversation with their doctor about the potential benefits, risks, costs and limitations of screening.

NCCN recommends that people with inherited mutations in the following genes (with or without a family history of cancer) "consider pancreatic cancer screening" with MRCP or EUS:

• STK11: (Peutz-Jeghers syndrome): Consider pancreatic cancer screening by MRCP or EUS every 1-2 years beginning at age 30-35 or 10 years younger than the earliest pancreatic cancer in the family.
• CDKN2A: Consider pancreatic cancer screening beginning at age 40 or 10 years earlier than the earliest pancreatic cancer diagnosis in the family.

NCCN guidelines recommend that people with an inherited mutation in one of the following genes and a family history of pancreatic cancer "consider pancreatic cancer screening" with MRCP or EUS beginning at age 50 or 10 years earlier than the earliest pancreatic cancer diagnosis in the family:

• ATM
• BRCA1
• BRCA2 
• MLH1
• MSH2
• MSH6
• EPCAM
• PALB2 
• TP53 

American Society for Gastrointestinal Endoscopy (ASGE) Guidelines

The ASGE released new guidelines on pancreatic cancer screening for people with a BRCA1 and BRCA2 mutation. These guidelines are different from NCCN guidelines for people with BRCA1 and BRCA2 mutations. ASGE recommends:

• All people with a BRCA1 or BRCA2 mutation regardless of family history of pancreatic cancer, should undergo annual  screening for pancreatic cancer with MRI/MRCP or EUS beginning at age 50 (or 10 years earlier than the earliest pancreatic cancer in the family).  

If you have an inherited mutation that increases your risk for pancreatic cancer, talk with your healthcare team to decide if pancreatic cancer screening is right for you.