While Academic Medical Centers excel at treating advanced pancreatic cancer, most lack the systematic infrastructure to manage the estimated 40 million Americans with a pancreatic cyst, a key indicator of elevated pancreatic cancer risk¹. It's a clinical gap that results in preventable late-stage diagnoses and missed opportunities for early intervention when outcomes are dramatically better.

Health system attention and investment in pancreatic cancer significantly lag the "big four" cancers (breast, lung, prostate, and colorectal), where established screening criteria facilitate earlier and more widespread diagnosis. The disparity in outcomes is stark.

The case-to-death ratios reveal the crisis in stark terms. For every 7.5 patients diagnosed with breast cancer, one will die. For pancreatic cancer, that ratio plummets to 1.3, meaning more than three-quarters of patients diagnosed will not survive. Only lung cancer approaches this grim figure at 1.8.

The incidence of pancreatic cancer has risen by 1% annually since the late 1990s², and the disease is increasingly affecting younger patients, a demographic shift that would have been unheard of 15 years ago³. Yet while we've built sophisticated, scalable infrastructure for breast, lung, and colorectal cancer screening and surveillance, pancreatic cyst management remains largely ad hoc, manual, and inconsistent.

Why This Gap Persists, and Why AMCs Can Close It

We have evidence-based guidelines for IPMN surveillance intervals and intervention thresholds¹. We understand that patients with Intraductal Papillary Mucinous Neoplasms require longitudinal management and appropriate intervention to catch disease progression early. The challenge is operational: most health systems lack the scalable infrastructure to systematically identify, track, and manage these patients over time.

Pancreatic cysts are typically discovered incidentally during imaging performed for other reasons. Without a systematic approach, what happens next depends on factors that shouldn't matter: which radiologist read the scan, whether the ordering physician recognizes the significance, whether someone manually tracks the follow-up recommendation, and whether the patient understands the importance of surveillance. Too many patients fall through the cracks, not because of inadequate clinical expertise, but because of inadequate systems.

Academic Medical Centers are uniquely positioned to solve this problem. Unlike community hospitals, AMCs own the full continuum of care, from initial imaging through specialized pancreatic surgery, and have the clinical depth to build truly sophisticated surveillance programs. The question is how to translate that clinical expertise into systematic, scalable operations that can manage thousands of patients without overwhelming clinical staff.

What Systematic Surveillance Actually Requires

Building an effective pancreatic cyst surveillance program requires addressing three distinct operational challenges:

1. Systematic Identification and Clinical Validation

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An AMC performing approximately 730,000 radiology scans annually will likely identify several thousand patients requiring pancreatic cyst surveillance, far more than clinical teams can manually manage. The first requirement is automating the identification process using condition-specific algorithms that can extract and validate relevant clinical characteristics like duct dilation, cyst size, and finding type from radiology reports.

The validation step is particularly critical yet often overlooked. Not every mention of a pancreatic finding requires surveillance, and determining clinical significance currently requires staff to navigate disparate systems to extract and synthesize information. Effective automation must deliver actionable clinical intelligence, not just surface findings that still require extensive manual review.

2. Evidence-Based Risk Stratification at the Point of Care

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Not every patient with a pancreatic cyst will develop pancreatic cancer, but those at higher risk need appropriate longitudinal management. The challenge many health systems face is translating the specialized expertise of pancreatic specialists into clinical guidance that's accessible systemwide to radiologists, primary care physicians, and care coordinators who may not routinely manage these patients.

This requires systems that can instantly generate evidence-based next steps based on validated clinical findings, without disrupting existing workflows. When implemented effectively, this approach eliminates clinical ambiguity and ensures patients receive appropriate care regardless of how or where their cyst was discovered.

3. Proactive Longitudinal Management

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Identifying patients and generating recommendations solves only part of the problem. What separates successful surveillance programs from aspirational ones is the ability to ensure patients actually receive recommended follow-up care over months and years. Was the follow-up appointment scheduled? Is the primary care physician aware of the finding? Has an appropriate imaging order been placed? When a follow-up scan is completed, does someone review it against the patient's surveillance history.

Answering these questions manually is resource-intensive and doesn't scale. Advanced surveillance programs use bidirectional EMR integrations to automate tracking, proactively identify when patients are overdue for surveillance, and flag when new imaging indicates elevated risk requiring accelerated follow-up. This level of automation allows clinical staff to focus on complex cases and patient navigation rather than administrative tracking.

The Downstream Impact: Clinical and Financial Alignment

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When academic medical centers build systematic pancreatic cyst surveillance programs, several things happen simultaneously. Patient outcomes improve as early-stage disease is caught when intervention is most effective. Clinical teams work more efficiently, focusing expertise on complex cases rather than manual tracking. The financial impact is substantial. Retaining and appropriately managing these patients within an AMC's network generates significant downstream revenue while providing genuinely better care.

A health system managing several thousand surveillance patients can expect substantial annual revenue from imaging, specialist consultations, procedures, and when necessary, surgical intervention. These are patients who already need care and are already in your system. The question is whether you have the infrastructure to provide that care systematically and well, or whether patients slip through gaps in manual processes until they present with late-stage disease.

Building scalable surveillance infrastructure allows AMCs to deliver the standard of care they already aspire to provide, while capturing care that would otherwise fragment across the community or be delayed until outcomes are worse and treatment is more complex.

Moving from Aspiration to Implementation

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Most AMCs already have some form of pancreatic surveillance program: a committed clinical champion, a nurse navigator, a referral pathway. What's often missing is the technological infrastructure to make that program truly systematic and scalable. The gap between "we manage high-risk pancreatic cysts" and "we systematically identify and manage all appropriate patients" is the difference between a pilot program and a comprehensive service line.

As health systems evaluate how to build this infrastructure, several considerations matter more than others. The technology must be purpose-built for this clinical application. Generic care management tools typically lack the condition-specific intelligence required for accurate identification and risk stratification. Implementation requires genuine partnership between technology vendors and clinical teams to adapt evidence-based guidelines to an organization's specific workflows and culture of medicine. And the solution must integrate deeply enough with existing systems to automate administrative burden, not just add new dashboards that still require manual oversight.

The opportunity in pancreatic cancer care is systematizing and scaling what AMCs already do well, ensuring that clinical expertise and evidence-based protocols reach every patient who needs them, not just those who happen to navigate the right pathway.

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