Target population | ||
Peutz-Jeghers syndrome (carriers of a germline LKB1/STK11 gene mutation) Germline CDKN2A mutation Germline BRCA2, BRCA1, PALB2, ATM, MLH1, MSH2, or MSH6 gene mutation with at least one affected first-degree blood relative Individuals who have at least one first-degree relative with PC who in turn also has a first-degree relative with PC (FPC kindred) | ||
The onset of screening | ||
FPC kindred (without a known germline mutation) | Start at age 50 or 55 or 10 years younger than youngest affected blood relative | |
Mutation carriers: for CDKN2A, Peutz-Jeghers syndrome, | Start at age 40 or 10 years younger than the youngest affected blood relative | |
Mutation carriers: for BRCA2, ATM, PALB2, BRCA1, MLH1/MSH2 | Start at age 45 or 50 or 10 years younger than the youngest affected blood relative | |
Method of screening | ||
At baseline | MRI/MRCP + EUS + fasting blood glucose and/or HbA1c | |
Follow-up | Alternate MRI/MRCP and EUS (no consensus if and how to alternate) | |
Routinely test fasting blood glucose and/or HbA1c | ||
On indication | Serum CA 19–9 | If suspected features on imaging |
EUS-FNA only | Solid lesions of ≥5 mm | |
Cystic lesions with suspected features | ||
Asymptomatic MPD strictures (regardless of tumor presence) | ||
CT only | Solid lesions, regardless of size | |
Asymptomatic MPD strictures of unknown etiology (without tumor) | ||
Intervals | ||
12 months | If no abnormalities, or only non-concerning abnormalities (e.g., pancreatic cysts without suspected features) | |
3 or 6 months | If suspected abnormalities for which immediate surgery is not indicated |