Areas of Uncertainty in Pancreatic Cancer Surveillance: A Survey Across the International Pancreatic Cancer Early Detection (PRECEDE) Consortium
Bibliographic record
Abstract
PURPOSE Pancreatic cancer (PC) surveillance is increasingly recommended for high-risk individuals, but there are remaining areas of uncertainty that are not consistently addressed by guidelines contributing to heterogeneity in clinical practice. Herein, we compare PC surveillance practices across sites in the international Pancreatic Cancer Early Detection (PRECEDE) Consortium to understand the application of eligibility criteria and testing strategies among experienced PC surveillance centers. METHODS This analysis represents a cross-sectional survey administered in 2024 to PRECEDE institutions. The site principal investigator (or designee) completed the survey reflecting PC surveillance practices of their site, with one response per institution. Survey questions were related to surveillance eligibility for carriers of BRCA1/2 , ATM , PALB2 , and Lynch syndrome along with imaging approaches. RESULTS Of the 57 PRECEDE sites, 54 (95%) completed the survey. For high-risk gene carriers, there was heterogeneity among sites with respect to whether family history of PC was used when assessing eligibility for surveillance. In the absence of family history, 44.4% and 35.2% of sites would offer PC surveillance to BRCA2 and BRCA1 carriers, respectively, whereas 31.5% and 13% would offer surveillance to PALB2/ATM and Lynch syndrome carriers, respectively. There was general consensus that surveillance should start at age 50 for men and women across all included genes. Magnetic resonance imaging with magnetic resonance cholangiopancreatography was used by 64.8% of sites as index imaging. The majority recommended an alternative modality if index imaging was unremarkable, and recommended annual surveillance imaging. CONCLUSION This is the largest assessment of global PC surveillance practices to date, showing variability in practice patterns. Additional investigation is needed to refine risk stratification for gene carriers without a family history of PC and address optimal imaging strategies.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".