JCO Precision Oncology · Nov 3, 2026
Longitudinal Pancreatic Imaging Findings in BRCA1 , BRCA2 , ATM, and PALB2 Heterozygotes Undergoing Pancreatic Cancer Surveillance: A Prospective PRECEDE Consortium Study
By Kasselman S, Long JM, Hartman TR et al.
Purpose: Imaging surveillance for pancreatic cancer (PC) is recommended for select high-risk individuals (HRIs) with a goal of downstaging PC diagnosis and improving long-term survival. A common subgroup of HRIs undergoing PC surveillance imaging includes those with a heterozygous pathogenic germline variant (PGV) in breast cancer susceptibility genes BRCA1 , BRCA2 , ATM , or PALB2. Despite expanding recommendations for PC surveillance imaging in these individuals, limited evidence exists to guide counseling regarding the frequency and longitudinal outcomes of imaging findings. Methods: The Pancreatic Cancer Early Detection (PRECEDE) Consortium is a prospective multicenter cohort study of HRIs undergoing PC surveillance imaging. In this study, we report imaging outcomes across the first 5 years of enrollment (April 2020-April 2025) for PRECEDE participants with a heterozygous PGV in BRCA1 , BRCA2 , ATM , or PALB2 . Results: Among 2,085 eligible participants, PGVs in BRCA2 (51%) were most common, followed by BRCA1 (21%), ATM (19%), and PALB2 (9%). Baseline pancreatic imaging occurred primarily with endoscopic ultrasound (EUS; 55%) or magnetic resonance imaging (43%). More than half (54%) of the participants had at least 1 pancreatic imaging finding during the study, while concerning findings including worrisome cysts, main pancreatic duct dilation ≥5 mm, and solid masses were detected in 9.1% of the cohort. Among HRIs without a pancreatic cyst or solid mass at baseline imaging, 71% remained without findings after at least two follow-ups. Additionally, 87% of HRIs with pancreatic cysts and follow-up imaging using the same modality did not have worrisome cyst growth. Conclusion: In this largest reported cohort of BRCA1 , BRCA2 , ATM , and PALB2 heterozygotes undergoing PC surveillance imaging, benign/low-risk pancreatic imaging findings were common and stable on short-term follow-up, providing important data for counseling these HRIs.