Russell Langan, MD, FACS, FSSO, Director of Surgical Oncology, RWJBarnabas Health, Associate Professor of Surgery, Rutgers Cancer Institute
Pancreatic cancer is one of the deadliest. Of the more than 67,000 people estimated to be diagnosed with pancreatic cancer each year, more than 52,000 are likely to die. Many of those deaths may be preventable. Pancreatic cysts, particularly mucinous types, are the most common identifiable precursor lesions for pancreatic cancer and are often found incidentally — in unrelated imaging reports. Systematically tracking these pancreatic cysts and ensuring patients receive evidence based treatment can improve pancreatic cancer outcomes by removing high risk cysts before they develop into invasive pancreatic cancer.
Here are five key reasons why health systems should take a proactive rather than reactive approach to pancreatic cyst surveillance in order to improve pancreatic cancer outcomes:
Health systems encounter patients at risk for pancreatic cancer every day. Pancreatic cysts are not rare findings — up to 20% of all MRIs performed in the U.S. include an incidental pancreatic cyst finding. Appropriately managed, these can be opportunities to improve care and outcomes. Unfortunately, more than half are never followed up on. They are either not put into an ongoing surveillance pathway or fall off due to inconsistent follow-up care or communication gaps. Every one of these is a missed opportunity for improving future health outcomes for those patients who go on to develop pancreatic cancer.
Pancreatic cysts, especially mucinous types like intraductal papillary mucinous neoplasms (IPMNs) and mucinous cystic neoplasms (MCNs), are known precursors to cancer. While they cannot be prevented, early identification and appropriate follow-up can dramatically alter the disease trajectory and, therefore, outcomes. Once they are uncovered, guideline-based surveillance and risk stratification can meaningfully improve outcomes before the disease progresses to later, more difficult-to-treat stages.
Unfortunately, many pancreatic cyst surveillance programs still rely on fragmented systems and outdated models. Some of the challenges with current models include:
Without centralized oversight and intelligent systems, many patients are left at risk, and those with the greatest clinical need often face the biggest barriers to care. This also leads to disparities.
Many pancreatic cysts are incidentally discovered during imaging for unrelated conditions. These findings are documented, but without a formal, dynamic surveillance program in place, they are rarely tracked, leading to missed opportunities for intervention when the disease is still manageable.
While many pancreatic cysts are low-risk and those patients do not go on to develop cancer, for those that do, catching the disease early can make the difference between life and death.
Pancreatic cancers
identified
Growth in new
patients
Downstream exams
generated
Pancreatic cancers
found in stages I, II, and III
Successful return rate
for high-risk patients
These metrics demonstrate what is possible when clinical intelligence, evidence-based guidelines, and automation are integrated into a single system. Surveillance becomes scalable. Outcomes improve. Patients receive the care they need on time. Pancreatic cysts are more than incidental findings. They are one of the few opportunities clinicians have to intervene before pancreatic cancer advances and becomes treatment-resistant.
Health systems that modernize their surveillance approach can change the narrative. They can detect pancreatic cancer earlier, when a positive outcome is still within reach, reduce care disparities, and close gaps in follow-up.
