La Revue du Praticien · Oct 2026
Screening for pancreatic adenocarcinoma in high-risk individuals
By Védie AL, de Mestier L
Pancreatic adenocarcinoma (PA) has a poor prognosis, with a lifetime risk of 0.5-1.3% in the general population. Only high-risk individuals (HRI), defined by a relative risk >5 or a cumulative risk >5%, warrant screening. Constitutional risk factors (genetic mutations, familial aggregation) help identify these HRI.HRI include carriers of PRSS1, LKB1/STK11, or CDKN2A mutations, regardless of family history, carriers of BRCA1/2, PALB2, ATM, MLH1, MSH2, MSH6, PMS2, TP53, or APC mutations, with at least one first-degree relative affected by PA, individuals with familial aggregation of PA (at least 3 family cases including one first-degree relative, or a first-degree relative with another first-degree relative affected). Screening is based on annual pancreatic MRI and endoscopic ultrasound, performed in expert centers, alternating every six months. The goal is to detect precancerous lesions (IPMN, high-grade PanIN) or early-stage PA amenable to curative resection. Screening is typically discontinued at age 75-80. PA screening in HRI, although resource-intensive, improves survival and requires multidisciplinary management, including psychological support.