{"entity":{"id":"pancreatic-surveillance","kind":"technology","name":"High-risk pancreatic surveillance (CAPS / PRECEDE)","aka":[],"tldr":"Yearly MRI or endoscopic ultrasound for people with inherited risk, which catches pancreatic cancers while they are still operable.","summary":"The Cancer of the Pancreas Screening (CAPS) consortium and the PRECEDE consortium (>50 centres) follow carriers of BRCA2, PALB2, ATM, CDKN2A, STK11, Lynch genes, and familial pancreatic cancer kindreds with annual MRI/MRCP or EUS. In CAPS5 (2022), 77% of screen-detected cancers were stage I versus ~15% in the general population, with 5-year survival ~73%. Blood tests (CA19-9 glycan variants, MCED) and AI on prior CTs aim to extend surveillance to new-onset diabetes and other higher-risk groups.","status":"established","asOf":"2026-09-06","links":[{"label":"PRECEDE consortium","url":"https://precedestudy.org/"}],"tags":[],"related":[],"cancers":["pancreatic","ipmn-cystic-precursors","brca-palb2-pdac"],"sections":["early-detection"],"technologies":["mri","ultrasound","germline-testing","mced"],"targets":["brca"],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["stage-shift"],"trials":[],"people":[],"bottlenecks":[],"keyPapers":["paper-canto-caps-long-term-surveillance-gastroenterology-2018","paper-caps-consortium-surveillance-recommendations-gut-2020","paper-dbouk-caps5-stage-survival-jco-2022","paper-gonda-precede-consortium-recommendations-gastroenterology-2021","paper-worthington-precede-early-detection-biomarkers-ijc-2026"],"journals":[],"dependsOn":[],"notes":["Pancreatic cancer: across CAPS1 to 5 (1,731 high-risk individuals) 57.9% of the cancers found in surveillance were stage I, with median overall survival 9.8 years against 1.5 years for cancers diagnosed outside it (hazard ratio 0.13; Dbouk 2022); the progression rate under surveillance is about 1.6% a year and 9 of 10 surveillance-detected cancers were resectable (Canto 2018). The 2020 CAPS consensus starts at 50, or ten years before the youngest affected relative, with annual endoscopic ultrasound and MRI, and admits ATM carriers with one affected first-degree relative (Goggins 2020)."],"principle":"Annual cross-sectional imaging of the pancreas in a population with 5-10x baseline risk; resection of high-grade precursor lesions and early cancers.","strengths":["Stage shift to resectable disease in carriers","Defines the population for blood-test validation"],"limitations":["Only ~10% of pancreatic cancers arise in identifiable high-risk groups","Cyst overtreatment risk","Cost and adherence"]},"route":"/technologies/pancreatic-surveillance/","neighbours":{"cancer":[{"id":"brca-palb2-pdac","kind":"cancer","name":"BRCA or PALB2-mutant pancreatic ductal adenocarcinoma","route":"/cancers/brca-palb2-pdac/"},{"id":"pancreatic-colloid-carcinoma","kind":"cancer","name":"Colloid (mucinous non-cystic) carcinoma of the pancreas","route":"/cancers/pancreatic-colloid-carcinoma/"},{"id":"ipmn-cystic-precursors","kind":"cancer","name":"Intraductal papillary mucinous neoplasm and other pancreatic cystic precursors","route":"/cancers/ipmn-cystic-precursors/"},{"id":"ipmn-associated-carcinoma","kind":"cancer","name":"Invasive carcinoma arising in an intraductal papillary mucinous neoplasm (IPMN-associated carcinoma)","route":"/cancers/ipmn-associated-carcinoma/"},{"id":"pancreatic","kind":"cancer","name":"Pancreatic ductal adenocarcinoma","route":"/cancers/pancreatic/"},{"id":"resectable-pdac","kind":"cancer","name":"Resectable pancreatic ductal adenocarcinoma","route":"/cancers/resectable-pdac/"}],"section":[{"id":"early-detection","kind":"section","name":"Early Detection & Screening","route":"/fronts/early-detection/"}],"technology":[{"id":"germline-testing","kind":"technology","name":"Germline (hereditary) testing","route":"/technologies/germline-testing/"},{"id":"mri","kind":"technology","name":"MRI","route":"/technologies/mri/"},{"id":"mced","kind":"technology","name":"Multi-cancer early detection (MCED)","route":"/technologies/mced/"},{"id":"serum-tumour-markers","kind":"technology","name":"Serum tumour markers: proper use and misuse","route":"/technologies/serum-tumour-markers/"},{"id":"ultrasound","kind":"technology","name":"Ultrasound","route":"/technologies/ultrasound/"}],"target":[{"id":"brca","kind":"target","name":"BRCA1 / BRCA2 (HRD)","route":"/targets/brca/"}],"term":[{"id":"ca19-9","kind":"term","name":"CA 19-9","route":"/terms/ca19-9/"},{"id":"caps-consortium-pancreatic-screening","kind":"term","name":"CAPS: the Cancer of the Pancreas Screening consortium and its surveillance studies (CAPS1 to CAPS5)","route":"/terms/caps-consortium-pancreatic-screening/"},{"id":"familial-pancreatic-cancer","kind":"term","name":"Familial pancreatic cancer and inherited risk (who qualifies for surveillance)","route":"/terms/familial-pancreatic-cancer/"},{"id":"pancreatic-cyst-high-risk-stigmata","kind":"term","name":"High-risk stigmata and worrisome features of pancreatic cysts (IPMN and MCN surgical criteria)","route":"/terms/pancreatic-cyst-high-risk-stigmata/"},{"id":"new-onset-diabetes-pancreatic-cancer","kind":"term","name":"New-onset diabetes as a signal of pancreatic cancer (and the ENDPAC score)","route":"/terms/new-onset-diabetes-pancreatic-cancer/"},{"id":"panin","kind":"term","name":"Pancreatic intraepithelial neoplasia (PanIN), the microscopic precursor of pancreatic cancer","route":"/terms/panin/"},{"id":"stage-shift","kind":"term","name":"Stage shift","route":"/terms/stage-shift/"}],"paper":[{"id":"paper-hu-germline-mutations-pancreatic-cancer-risk-jama-2018","kind":"paper","name":"Association Between Inherited Germline Mutations in Cancer Predisposition Genes and Risk of Pancreatic Cancer","route":"/key-papers/paper-hu-germline-mutations-pancreatic-cancer-risk-jama-2018/"},{"id":"paper-yachida-metastasis-late-genetic-evolution-pancreatic-nature-2010","kind":"paper","name":"Distant metastasis occurs late during the genetic evolution of pancreatic cancer","route":"/key-papers/paper-yachida-metastasis-late-genetic-evolution-pancreatic-nature-2010/"},{"id":"paper-noe-cyst-malignant-progression-genomics-nat-commun-2020","kind":"paper","name":"Genomic characterization of malignant progression in neoplastic pancreatic cysts","route":"/key-papers/paper-noe-cyst-malignant-progression-genomics-nat-commun-2020/"},{"id":"paper-caps-consortium-surveillance-recommendations-gut-2020","kind":"paper","name":"Management of patients with increased risk for familial pancreatic cancer: updated recommendations from the International Cancer of the Pancreas Screening (CAPS) Consortium","route":"/key-papers/paper-caps-consortium-surveillance-recommendations-gut-2020/"},{"id":"paper-sharma-endpac-model-new-onset-diabetes-gastroenterology-2018","kind":"paper","name":"Model to Determine Risk of Pancreatic Cancer in Patients With New-Onset Diabetes","route":"/key-papers/paper-sharma-endpac-model-new-onset-diabetes-gastroenterology-2018/"},{"id":"paper-worthington-precede-early-detection-biomarkers-ijc-2026","kind":"paper","name":"Pancreatic cancer early detection biomarkers for high-risk individuals: insights from the PRECEDE consortium","route":"/key-papers/paper-worthington-precede-early-detection-biomarkers-ijc-2026/"},{"id":"paper-makohon-moore-precursor-cells-ductal-system-nature-2018","kind":"paper","name":"Precancerous neoplastic cells can move through the pancreatic ductal system","route":"/key-papers/paper-makohon-moore-precursor-cells-ductal-system-nature-2018/"},{"id":"paper-gonda-precede-consortium-recommendations-gastroenterology-2021","kind":"paper","name":"Recommendations for a more organized and effective approach to the early detection of pancreatic cancer from the PRECEDE (Pancreatic Cancer Early Detection) consortium","route":"/key-papers/paper-gonda-precede-consortium-recommendations-gastroenterology-2021/"},{"id":"paper-canto-caps-long-term-surveillance-gastroenterology-2018","kind":"paper","name":"Risk of Neoplastic Progression in Individuals at High Risk for Pancreatic Cancer Undergoing Long-term Surveillance","route":"/key-papers/paper-canto-caps-long-term-surveillance-gastroenterology-2018/"},{"id":"paper-dbouk-caps5-stage-survival-jco-2022","kind":"paper","name":"The Multicenter Cancer of Pancreas Screening Study: Impact on Stage and Survival","route":"/key-papers/paper-dbouk-caps5-stage-survival-jco-2022/"},{"id":"paper-roberts-familial-pancreatic-whole-genome-cancer-discov-2016","kind":"paper","name":"Whole genome sequencing defines the genetic heterogeneity of familial pancreatic cancer","route":"/key-papers/paper-roberts-familial-pancreatic-whole-genome-cancer-discov-2016/"}],"idea":[{"id":"idea-mced-new-onset-diabetes","kind":"idea","name":"Blood-based pancreatic cancer detection in new-onset diabetes","route":"/ideas/idea-mced-new-onset-diabetes/"},{"id":"idea-pdac-new-onset-diabetes-risk-score-pathway","kind":"idea","name":"Run the ENDPAC score on every new diabetes diagnosis after 50 and scan the high scorers","route":"/ideas/idea-pdac-new-onset-diabetes-risk-score-pathway/"},{"id":"idea-pdac-surveillance-for-every-germline-carrier","kind":"idea","name":"Surveillance for every germline carrier found by universal testing, inside a registry rather than a research exception","route":"/ideas/idea-pdac-surveillance-for-every-germline-carrier/"}],"roadmap":[{"id":"pancreatic-roadmap","kind":"roadmap","name":"Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question","route":"/roadmaps/pancreatic-roadmap/"}],"bottleneck":[{"id":"b-early-detection","kind":"bottleneck","name":"The hardest cancers are found late","route":"/bottlenecks/b-early-detection/"}],"institution":[{"id":"nebraska-buffett","kind":"institution","name":"Fred & Pamela Buffett Cancer Center","route":"/institutions/nebraska-buffett/"}],"trial":[{"id":"precede","kind":"trial","name":"PRECEDE","route":"/trials/precede/"}]}}