Predicting pancreatic cancer in high-risk individuals and in the general population: how long is the road yet?

Pancreatic ductal adenocarcinoma (PDAC) remains a significant global health burden, projected to become the second leading cause of cancer-related mortality in the Western world by 2030. Due to the lack of effective population-wide screening methods, targeted surveillance of high-risk individuals-those with a lifetime risk exceeding 5-10% based on family history or pathogenic germline variants-represents the most viable strategy for early detection. Current surveillance protocols utilize endoscopic ultrasound (EUS) and magnetic resonance imaging (MRI) to identify potentially curable T1N0M0 tumors or high-grade precursor lesions. Clinical evidence demonstrates that these programs significantly improve outcomes, increasing the detection of stage I tumors and raising 5-year overall survival rates from 9% to 50%. This editorial emphasizes that the future effectiveness of PDAC prevention lies in refined risk stratification through universal germline testing, the integration of polygenic and environmental data, and the provision of comprehensive psychosocial support to manage the emotional impact of surveillance.