Chinese consensus on early screening and surveillance for pancreatic cancer in high-risk individuals (2026 revision, Nanjing)

This updated consensus presents 26 evidence‑based recommendations for early screening and surveillance of pancreatic cancer in high‑risk populations in China. Using GRADE methodology and a modified Delphi process (≥75% agreement), a multidisciplinary panel of 53 experts from 17 provinces defined high‑risk groups (hereditary susceptibility, new‑onset diabetes, chronic pancreatitis with PRSS1 mutations, and pancreatic cystic neoplasms), specified starting ages, surveillance intervals, imaging modalities (MRI/MRCP, EUS, CT), surgical indications, and lifestyle modifications. Of the 26 recommendations, 14 are strong and 12 are weak (evidence levels A–D). Implementation aims to improve early diagnosis of stage I pancreatic cancer and high‑grade precursor lesions, ultimately improving survival and quality of life.

Introduction
Pancreatic cancer has a 5‑year survival of ~13%. In China, it ranks 8th in incidence and 6th in mortality. The PanIN‑to‑carcinoma transition takes ~21 years, offering a window for early detection. This 2026 revision updates the 2021 consensus with new evidence, balancing benefits, harms, and real‑world feasibility in China.

Methods
A multidisciplinary panel (53 experts: 45 gastroenterologists, 6 pancreatic surgeons, 1 radiologist, 1 pathologist) conducted systematic literature reviews, appraised evidence with GRADE (A–D), and used a modified Delphi process (≥75% agreement) to formulate 26 recommendations (14 strong, 12 weak).

Key Recommendations

Goals

• Rec 1: Detect stage I pancreatic cancer and high‑grade PanIN (A, Strong).

Target populations

• Rec 2: Do not screen asymptomatic non‑high‑risk individuals (C, Weak).

• Rec 3: Screen hereditary risk, new‑onset diabetes, chronic pancreatitis, and pancreatic cystic neoplasms (B, Strong).

• Rec 4: Screen individuals with ≥2 first‑degree relatives with pancreatic cancer (B, Strong).

• Rec 5: Screen all Peutz‑Jeghers (STK11) and CDKN2A carriers, regardless of family history (A, Strong).

• Rec 6: Screen BRCA1/2, PALB2, ATM, MLH1/MSH2/MSH6, or APC carriers with ≥1 affected first‑degree relative (B, Strong).

• Rec 7: Screen new‑onset diabetes >50 years with BMI <25 kg/m² and/or unexplained weight loss >3.6 kg in 2 years (B, Weak).

• Rec 8: Screen new‑onset diabetes with hereditary risk, irrespective of age (C, Weak).

• Rec 9: Screen hereditary chronic pancreatitis with PRSS1 mutations; do not screen others (C, Weak).

• Rec 10: Perform genetic testing (especially PRSS1) in chronic pancreatitis of unknown etiology (C, Weak).

• Rec 11: Screen BD‑IPMN upon diagnosis; refer MCN, SPN, cNET, MD‑IPMN, MT‑IPMN for MDT surgical discussion (C, Weak).

Starting age

• Rec 12: Family history: age 50 or 10 years before youngest affected relative; Peutz‑Jeghers: 35; CDKN2A: 40; other mutation carriers: 50 or 10 years before youngest relative (B, Strong).

• Rec 13: New‑onset diabetes: immediately after diagnosis (C, Weak).

• Rec 14: Chronic pancreatitis: age 40 (C, Weak).

• Rec 15: BD‑IPMN: immediately after diagnosis, regardless of age (C, Weak).

Surveillance intervals

• Rec 16: Hereditary/diabetes/pancreatitis: 12 months if no abnormalities; 3–6 months if worrisome features (C, Weak).

• Rec 17: BD‑IPMN: 12 months for cysts <2 cm, 6 months for 2–3 cm; shorten to 3–6 months if worrisome features develop (B, Strong).

• Rec 18: Postoperative: annual if no residual; if low‑grade dysplasia at margins, CA19‑9 and imaging ≥ twice yearly (B, Strong).

Imaging

• Rec 19: Initial screening: fasting glucose/HbA1c, CA19‑9, and MRI/MRCP, EUS, or CT (C, Weak).

• Rec 20: Follow‑up: regular glucose/HbA1c, CA19‑9; alternating MRI/MRCP, EUS, or CT; pancreatoscopy for IPMN with MPD involvement (C, Weak).

• Rec 21: If solid lesion, cystic tumor with worrisome features, or asymptomatic MPD stenosis is detected, perform EUS‑FNA (B, Strong).

Surgical indications

• Rec 22: Malignant or suspicious EUS‑FNA → surgical resection after MDT (A, Strong).

• Rec 23: Solid lesion >10 mm or MPD narrowing/dilation ≥10 mm with indeterminate EUS‑FNA → MDT and surgical exploration (B, Strong).

• Rec 24: BD‑IPMN with high‑risk stigmata (solid lesion, obstructive jaundice, enhancing mural nodules ≥5 mm, MPD ≥10 mm) → resection after MDT (B, Strong).

Lifestyle

• Rec 25: Quit smoking/drinking, balanced diet, moderate exercise, avoid obesity (B, Strong).

Screening centers

• Rec 26: Conduct surveillance at pancreatic specialty centers (≥20 pancreaticoduodenectomies/year, standing MDT, advanced diagnostics) (C, Strong).

Potential Harms
Screening must balance benefits against false positives, overdiagnosis, procedural risks, psychological burden, and costs. Over two‑thirds of surgeries in familial high‑risk individuals are for non‑malignant lesions. EUS/MRI require specialized infrastructure not uniformly available in China. Risk stratification and MDT decision‑making are essential.

Limitations
Most recommendations are supported by moderate‑to‑low certainty evidence (B or C). Health economic modeling specific to China’s regional disparities is not addressed. Long‑term outcomes require prospective Chinese cohort validation.

Future Directions
Key areas: risk assessment models, liquid biopsy (PancreaSure biomarker panel, portal venous CTC microfluidic biopsy), radiomics, AI‑enhanced CT analysis, and cost‑effectiveness optimization.

Conclusions
This consensus provides 26 evidence‑based recommendations for pancreatic cancer screening in high‑risk Chinese populations, defining target groups, starting ages, surveillance intervals, imaging, and surgical indications. Implementation at high‑volume centers with MDT support is expected to improve early diagnosis and outcomes.

Full text

https://www.xiahepublishing.com/2835-3315/CSP-2026-00004

The study was recently published in the Cancer Screening and Prevention.

Cancer Screening and Prevention (CSP) publishes high-quality research and review articles related to cancer screening and prevention. It aims to provide a platform for studies that develop innovative and creative strategies and precise models for screening, early detection, and prevention of various cancers. Studies on the integration of precision cancer prevention multiomics where cancer screening, early detection and prevention regimens can precisely reflect the risk of cancer from dissected genomic and environmental parameters are particularly welcome.

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