Pancreatic ductal adenocarcinoma (PDAC) is the fourth leading cause of cancer-related deaths in the United States

© Digestive Medicine Research. All rights reserved. Dig Med Res 2018;1:15 dmr.amegroups. com Pancreatic ductal adenocarcinoma (PDAC) is the fourth leading cause of cancer-related deaths in the United States and Europe (1). Symptoms are unusual at the early stages, and PDAC is most commonly diagnosed when it is at an incurable stage with only 15–20% of pancreatic cancers resectable at diagnosis (2). Despite improvements in medical and surgical management, PDAC is the only cancer whose mortality has not decreased in recent years (3). The median survival of patients with PDAC is 6 months, with a 5-year survival rate that remains extremely low (8.5%) (1). The first question that comes to mind after reading this data would be, is there anything we can do at present to improve this dreary prognosis? An early disease stage at diagnosis that allows curative intent surgery shows a markedly better survival rate, and provides the best opportunity of achieving long-term survival. Therefore, the best strategy currently available to improve outcomes in patients with PDAC is to develop effective screening protocols to help identify more patients who have it early on. Several criteria must be met to consider screening for a disease: the disease must be an important and prevalent health issue, precursor lesions must be detected during an early asymptomatic stage, testing for the disease must be suitable to the population screened, and effective treatment should be available (4). Population-based screening of pancreatic cancer is not recommended, due to its relative low incidence, along with the invasive nature of some of the screening modalities, as well as the morbidity associated with pancreatic surgery, and the globally poor survival results. Hence, efforts have focused on the identification of individuals who are at high risk for PDAC based upon family history, or an identified genetic predisposition who may potentially benefit from screening. Approximately 10% of PDAC cases have a familial aggregation (5), and a l though only a smal l number of PDAC are hereditary, genetic predisposition entails higher risk than environmental factors (6). In 2013, the International Cancer of the Pancreas Screening (CAPS) consortium published some consensus guidelines regarding pancreatic cancer screening. The guidelines were on evaluating who should be screened, how screening should be performed and how to define success from PDAC screening. The guidelines recommend screening for the following high-risk groups of patients: familial pancreatic cancer, (individuals with ≥2 first degree relatives with PDAC not associated with a genetic syndrome, and taking into account that the risk increases with the number of affected relatives) and genetic predisposition syndromes like, hereditary pancreatitis (PRSS1) and inherited cancer susceptibility syndromes with confirmed germline mutations (hereditary breast-ovarian cancer syndrome (BRCA1, BRCA2 and PALB2), familial atypical multiple mole and melanoma syndrome (CDKN2A or p16), Lynch syndrome, ataxia telangiectasia (ATM) and Peutz-Jeghers syndrome (STK11)). Cost-effectiveness studies of screening high-risk individuals have shown positive results (7). Complete pancreatic resection is the only method to assure survival for patients at risk of pancreatic cancer. However, its long-term consequences prevent this strategy. Since prophylactic total pancreatectomy is not recommended, the aim of PDAC screening is to detect early-stage pancreatic cancer, and high risk premalignant conditions, in order to treat them before the development of an invasive carcinoma. The natural history of PDAC Editorial