Longitudinal Pancreatic Imaging Findings in BRCA1, BRCA2, ATM, and PALB2 Heterozygotes Undergoing Pancreatic Cancer Surveillance: A Prospective PRECEDE Consortium Study

BRCA1, BRCA2, ATM, PALB2

Heterozygous germline pathogenic variants in BRCA1, BRCA2, ATM or PALB2

Imaging surveillance for pancreatic cancer is recommended for select high-risk individuals, including heterozygous carriers of a germline pathogenic variant in BRCA1, BRCA2, ATM or PALB2, but evidence on the frequency and course of imaging findings remains limited. The PRECEDE Consortium, a prospective multicentre cohort, reports the first five years of enrolment (April 2020 to April 2025) for 2,085 carriers of BRCA2 (51%), BRCA1 (21%), ATM (19%) and PALB2 (9%) variants, imaged at baseline mainly by endoscopic ultrasound (55%) or MRI (43%). More than half of participants (54%) had at least one pancreatic imaging finding, and concerning findings (worrisome cysts, main pancreatic duct dilation of 5 mm or more, solid masses) were detected in 9.1% of the cohort. Among individuals without a cyst or solid mass at baseline, 71% remained without findings after at least two follow-ups. Among cyst carriers followed with the same modality, 87% had no worrisome cyst growth.

Synthesis written by Geno'X. For the full original abstract, please refer to the source publication.

According to the authors, this is the largest reported cohort of such carriers under pancreatic surveillance, and it provides figures directly usable to warn patients about the frequency of benign findings before they enter the programme. Follow-up remains short and the abstract reports neither screen-detected cancers nor a survival benefit: the benefit-risk balance of surveillance, particularly in ATM or PALB2 carriers, remains to be established.

Analysis by Dr Thibaut Benquey