TOPLINE:

No significant differences were observed in the risk for intermediate pancreatic cancer on the basis of the extent of family history, suggesting little benefit of models that stratify screening risk based on differing numbers of first- and non-first-degree relatives who had pancreatic cancer. In addition, the family history burden did not modify the association between genetic alterations and intermediate-risk lesions.

METHODOLOGY:

• Familial pancreatic cancer syndrome is one of the most common indications for pancreatic cancer screening, but there are different criteria for this syndrome, and it is not well known whether they all carry the same risk for malignancy.
• To better understand the different criteria and the associated risks, investigators enrolled 541 high-risk patients undergoing pancreatic cancer screening at five centers between 2020 and 2024 in a prospective study.
• The patients were stratified on the basis of one of three proposed criteria for familial pancreatic cancer syndrome: having at least one affected first-degree relative (criterion 1); having two affected non-first-degree relatives on the same side of the family, with at least one being a first-degree relative to the participant (criterion 2); or having three affected non-first-degree relatives on the same side of the family, with at least one being a first-degree relative to the participant (criterion 3).
• The pancreatic outcomes were classified as either intermediate-risk (including neuroendocrine tumor [NET] < 2 cm or branch duct intraductal papillary mucinous neoplasm [IPMN]) or high-risk lesions (including high-grade pancreatic intraepithelial neoplasia or dysplasia, main duct IPMN, NET > 2 cm, or pancreatic cancer).

TAKEAWAY:

• Of the participants, 132 (24.4%) met criterion 1, 65 (12%) met criterion 2, and 51 (9.4%) met criterion 3, whereas 294 had zero or one relative with pancreatic cancer, with or without a genetic pathogenic variant.
• All three familial pancreatic cancer criteria showed similar risks for intermediate lesions: The odds ratio of developing intermediate-risk lesions for criterion 1 was 1.20 (P = .40), for criterion 2 was 1.23 (P = .46), and for criterion 3 was 1.41 (P = .29).
• The risks were also similar among patients with known genetic mutations, with and without first-degree relatives with pancreatic cancer.

IN PRACTICE:

“These findings support using the same recommendations for pancreatic cancer screening for all these subgroups of patients,” said the first author of the study.

The study also highlights “the need for larger cohorts to better define risk of high-grade lesions and pancreatic cancer,” he added.

SOURCE:

The findings, led by Andy Silva-Santisteban, MD, MPH, Beth Israel Deaconess Medical Center, Boston, were presented at Digestive Disease Week (DDW) 2026.

LIMITATIONS:

Because intermediate high-risk lesions were present in 35.1% of patients and high-risk lesions in only 1.5%, high-risk lesions were not analyzed due to the low numbers.

DISCLOSURES:

Silva-Santisteban reported having no disclosures.