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Cancer Screening — ABIM Board MCQ

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HardCancer ScreeningABIM Board

A 69-year-old man presents for preventive care. He has a 35-pack-year smoking history and quit 6 years ago. His BMI is 33 kg/m². Eight years ago, he had recurrent alcohol-associated pancreatitis; he has remained abstinent, but prior imaging showed pancreatic calcifications consistent with chronic pancreatitis. Type 2 diabetes mellitus was diagnosed 4 months ago after routine laboratory testing. He has no abdominal or back pain, jaundice, anorexia, or weight loss. His bilirubin and aminotransferase levels are normal. A maternal uncle developed pancreatic cancer at age 74. No other relatives have had pancreatic cancer, and there is no known pathogenic germline variant or hereditary cancer or pancreatitis syndrome in the family. He asks whether his risk factors warrant testing for pancreatic cancer. Which of the following is the most appropriate pancreatic cancer screening plan?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Do not initiate pancreatic cancer screening

Explanation lettering: C = shown as B · E = shown as C · B = shown as D · D = shown as E

The USPSTF recommends against pancreatic cancer screening in asymptomatic adults who are not known to be at high risk. Although this patient has several risk factors—older age, obesity, smoking, new-onset diabetes, and chronic pancreatitis—the USPSTF specifically classifies asymptomatic persons with these factors as part of the general population for screening purposes. A single affected second-degree relative, without a pathogenic germline variant, does not establish a familial pancreatic cancer kindred. Therefore, screening should not be initiated. MRI/MRCP (A), endoscopic ultrasonography (C), and combined or alternating MRI and endoscopic ultrasonography (D) are surveillance approaches considered for selected high-risk individuals, such as those with qualifying familial clustering, hereditary pancreatitis, Peutz-Jeghers syndrome, or certain pathogenic germline variants. This patient has alcohol-associated rather than hereditary pancreatitis and does not meet familial-risk criteria. CA 19-9 (E) lacks adequate accuracy for screening and can be elevated in benign pancreatic or biliary disease. New symptoms such as jaundice, unexplained weight loss, or persistent epigastric pain would warrant diagnostic evaluation rather than screening.

Reference: Pancreatic Cancer: Screening (August 6, 2019; checked August 27, 2026) — https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/pancreatic-cancer-screening AGA Clinical Practice Update on Pancreas Cancer Screening in High-Risk Individuals: Expert Review (2020) — https://pubmed.ncbi.nlm.nih.gov/32416142/