{"entity":{"id":"idea-prev-ipmn-surveillance-stop-rule","kind":"idea","name":"Stop watching stable low-risk pancreatic cysts after five years","aka":[],"tldr":"Small pancreatic cysts turn up on abdominal scans and are then followed for life. Low-risk cysts under 2 cm that are unchanged at five years rarely turn to cancer in Japanese and US cohorts, so a randomised trial of stopping surveillance would test whether years of scans can be spared.","summary":"Low-risk branch-duct IPMN under 2 cm that is stable at five years has low malignancy rates in Japanese and US cohorts, but guidelines diverge. Propose a randomised trial of surveillance cessation versus continued surveillance for stable low-risk cysts, with pancreatic cancer incidence and imaging burden as endpoints.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (Overdiagnosis and false alarms): Welch & Black, Overdiagnosis in cancer (JNCI 2010)","url":"https://doi.org/10.1093/jnci/djq099"}],"tags":[],"related":[],"cancers":["pancreatic","ipmn-cystic-precursors"],"sections":["early-detection","imaging"],"technologies":["mri"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-overdiagnosis"],"keyPapers":["paper-welch-j-natl-cancer-inst"],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"Cessation after five years of stability results in pancreatic cancer incidence under 1% over five further years, non-inferior to continued surveillance.","rationale":"Lifelong surveillance carries cost and anxiety; event rates in stable cysts are low.","test":"2,000-patient multicentre RCT.","maturity":"speculative","actor":"clinic","cost":"medium","horizonYears":6},"route":"/ideas/idea-prev-ipmn-surveillance-stop-rule/","neighbours":{"cancer":[{"id":"ipmn-cystic-precursors","kind":"cancer","name":"Intraductal papillary mucinous neoplasm and other pancreatic cystic precursors","route":"/cancers/ipmn-cystic-precursors/"},{"id":"pancreatic","kind":"cancer","name":"Pancreatic ductal adenocarcinoma","route":"/cancers/pancreatic/"}],"section":[{"id":"early-detection","kind":"section","name":"Early Detection & Screening","route":"/fronts/early-detection/"},{"id":"imaging","kind":"section","name":"Imaging","route":"/fronts/imaging/"}],"technology":[{"id":"mri","kind":"technology","name":"MRI","route":"/technologies/mri/"}],"bottleneck":[{"id":"b-overdiagnosis","kind":"bottleneck","name":"Overdiagnosis and false alarms","route":"/bottlenecks/b-overdiagnosis/"}],"paper":[{"id":"paper-welch-j-natl-cancer-inst","kind":"paper","name":"Overdiagnosis in cancer","route":"/key-papers/paper-welch-j-natl-cancer-inst/"}]}}