What are the recommended follow-up protocols for patients with risk factors for pancreatic cancer?

Recommended follow-up protocols for patients with risk factors for pancreatic cancer include:

• Consider surveillance for pancreatic cancer in people with two or more first-degree relatives affected across two or more generations, those with Lynch syndrome and any first-degree relatives with pancreatic cancer, hereditary pancreatitis with a PRSS1 mutation, and carriers of BRCA1, BRCA2, PALB2, or CDKN2A mutations with a family history of pancreatic cancer, as well as Peutz–Jeghers syndrome.
• Surveillance imaging should include MRI/MRCP or endoscopic ultrasound (EUS) for those without hereditary pancreatitis, and pancreatic protocol CT scans for those with hereditary pancreatitis and PRSS1 mutation. EUS is not recommended for pancreatic cancer detection in hereditary pancreatitis.
• Annual monitoring for pancreatic cancer is advised in people with hereditary pancreatitis due to their high lifetime risk (around 40%).
• For people with chronic pancreatitis, who have an increased risk of pancreatic cancer, regular clinical and biochemical assessment for pancreatic exocrine insufficiency and malnutrition should be offered at least every 12 months, with adjustment of treatment as needed.
• Monitoring for diabetes mellitus, especially type 3c diabetes, is important in chronic pancreatitis patients, with HbA1c testing recommended at least every 6 months, as new diabetes diagnosis may indicate increased pancreatic cancer risk.
• Bone density assessment every 2 years is recommended in chronic pancreatitis patients to manage osteoporosis risk.
• Referral to specialist pancreatic multidisciplinary teams is advised for decision-making and management in suspected or confirmed pancreatic cancer cases.

These protocols aim to identify pancreatic cancer early in high-risk individuals and manage associated complications effectively.

References: ¹,²,³