Pancreatic cancer is the fourth most common cause of cancer mortality in the
United States, with 5 year survival rates for patients with resectable tumors ranging from
15 - 20%. However, most patients present with distant metastases, are not
resectable, and have a 5-year survival of close to 0%. This demonstrates a need
for improved screening to identify pancreatic cancer while the tumor is localized and
amenable to surgical resection. Studies of patients with pancreatic tumors incidentally
diagnosed demonstrate longer median survival as compared with tumors discovered only when
the patient is symptomatic, suggesting that early detection may improve outcome. Recent
evidence from genomic sequencing indicates a 15 year interval for genetic progression of
pancreatic cancer from initiation to the metastatic stage, suggesting a sufficient window
for early detection. Still, many challenges remain in implementing effective screening.
Early diagnosis of pancreatic cancer relies on developing screening methodologies with
highly sensitive and specific biomarkers and imaging modalities. It also depends on a
better understanding of the risk factors and natural history of the disease in order to
accurately identify high risk groups that would be best served by screening. This review
summarizes our current understanding of the biology of pancreatic cancer relevant to
methods available for screening. At this time, given the lack of proven benefit in this
disease, screening efforts should probably be undertaken in the context of prospective
trials.