CLINICAL REVIEW Pancreatic cancer: early detection, diagnosis, and screening Rei Suzuki • Hiromasa Ohira • Atsushi Irisawa • Manoop S. Bhutani Received: 22 July 2012 / Accepted: 22 July 2012 / Published online: 10 August 2012 Ó Springer 2012 Abstract Pancreatic cancer, pancreatic ductal adenocar- cinoma, is one of the most lethal malignancies, and researchers have therefore intensified efforts directed at its early detection and management. Early detection includes an effective screening program, as pancreatic cancer is known to evolve from precursor lesions, which can be identified using currently available diagnostic modalities. A recent multicenter trial (the CAPS 3 trial) demonstrated that screening of asymptomatic individuals at high risk for pancreatic cancer frequently detects small cystic pancreatic lesions, including curable, noninvasive high-grade neo- plasms. In that study, endoscopic ultrasound and magnetic resonance imaging were better at detecting pancreatic lesions than was computed tomography. On the other hand, effective screening modalities (e.g., imaging studies with measurement of biomarkers) are lacking for individuals at normal to moderate risk for this disease. Therefore, pan- creatic cancer screening strategies should include identifi- cation of the population at high risk for this cancer and intensive application of screening tools with adequate sensitivity to detect early-stage disease. Keywords Pancreatic cancer Á Risk factor Á Diagnosis Á Screening Introduction Pancreatic cancer, pancreatic ductal adenocarcinoma, is one of the deadliest cancers. In the USA, it ranks tenth in newly diagnosed cancers and has the fourth highest esti- mated annual death rate among all cancers in both sexes [1]. Moreover, detection of pancreatic cancer at an early stage remains challenging, and only 10–20 % of patients have potentially resectable disease. As a result, the mor- tality rate for this cancer almost equals its incidence, with a 5-year survival rate of less than 10 %. In cases in which resection can be performed, the average survival duration ranges from 18 to 20 months, and the 5-year survival rate is as high as 20–25 %. Researchers have placed therefore increasing emphasis on early detection of pancreatic can- cer. Early detection includes an effective screening pro- gram that is biologically feasible, as pancreatic cancer is known to evolve from precursor lesions, which can be identified using currently available diagnostic modalities. This review will focus on the high-risk population, bio- markers and imaging techniques for pancreatic cancer screening. Individuals at high risk for pancreatic cancer Because early-stage pancreatic cancer is rarely marked by specific symptoms, screening should target asymptomatic individuals. However, considering the low incidence and prevalence of this cancer, screening the general population is not reasonable. Researchers recently estimated that the R. Suzuki Á M. S. Bhutani (&) Department of Gastroenterology, Hepatology and Nutrition, Unit 1466, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA e-mail: manoop.bhutani@mdanderson.org R. Suzuki Á H. Ohira Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan A. Irisawa Department of Gastroenterology, Fukushima Medical University Aizu Medical Center Preparatory Office, Fukushima, Japan 123 Clin J Gastroenterol (2012) 5:322–326 DOI 10.1007/s12328-012-0327-0