Risk-stratified surveillance for individuals in the UK at high risk of developing pancreatic cancer: Outcomes from the European Registry of Hereditary Pancreatic Diseases (EUROPAC).

Hopley, PJ.; Peysner, R.; Boughey, A.; Kewlani, B.; Smith, AM.; Aithal, GP.; Oppong, KW.; Finch-Jones, M.; Hamady, Z.; Athwal, TS.; Milburn, J.; Menon, S.; Chapman, M.; Pereira, SP.; Taylor, M.; Shingler, G.; Briggs, C.; Ghaneh, P.; Costello, E.; Greenhalf, W.; Halloran, CM.

Risk-stratified surveillance for individuals in the UK at high risk of developing pancreatic cancer: Outcomes from the European Registry of Hereditary Pancreatic Diseases (EUROPAC).

All Authors

Hopley, PJ.

Peysner, R.

Boughey, A.

Kewlani, B.

Smith, AM.

Aithal, GP.

Oppong, KW.

Finch-Jones, M.

Hamady, Z.

Athwal, TS.

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LTHT Author

Smith, Andrew Malvern

LTHT Department

Abdominal Medicine & Surgery
Upper Gastrointestinal Surgery

Publication Date

2026

Item Type

Journal Article
Observational Study

Subject

HOSPITALISATION , ADENOCARCINOMA , RISK FACTORS , POPULATION SURVEILLANCE , PANCREATIC NEOPLASMS , MIDDLE AGED , MEN , WOMEN , REGISTRIES , UNITED KINGDOM , ADULT , GENETIC PREDISPOSITION TO DISEASE , AGED , CARCINOMA , RISK ASSESSMENT , GENETIC TESTING , EARLY DIAGNOSIS

Abstract

BACKGROUND: Surveillance of individuals with a familial predisposition to pancreatic ductal adenocarcinoma (PDAC) is likely to increase overall survival. Our objective was to determine the impact of EUROPAC risk-stratification (Family Risk, FR), in such predisposed individuals. METHODS: Observational study of registered asymptomatic individuals undergoing surveillance for PDAC. Individuals without a known pathogenic variant (PV-), ineligible for genetic assessment in the NHS, in whom significant pancreatic lesions were found, were subjected to additional germline testing. RESULTS: Between January 2000 and April 2025, 893 individuals started surveillance, median age of 52 years. 508 individuals (404 PV- and 104 with a pathogenic variant (PV+)) in the 20 years prior to 2020 without stratification were compared to 385 (269 PV- and 116 PV+) in the five years from 2020 who had FR risk-stratification applied. Four (0.8%) individuals had actionable pancreatic findings prior to risk stratification vs. 14 (3.6%), who underwent risk-stratified surveillance (p=0.001). Pancreatic lesions deemed operable were found in three (0.6%) and 11 (3%), p=0.007, with two (0.4%) and nine (2%) undergoing resection, p=0.009, respectively. PV- individuals with significant findings were subsequently found to contain mutations, many not in the UK genetics test directory, provided the FR was >30. The median (IQR) time in surveillance prior to a lesion being detected was four (2 - 7) years. Overall, 78% of EUROPAC detected precursor lesions or pancreatic cancers were stage II or lower. CONCLUSION: The risk-stratified group (FR) identifies neoplastic pancreatic lesion in individuals, regardless of PV status suggesting the key usefulness of this approach.