Pancreatic ductal adenocarcinoma is expected to become the second-leading cause of cancer deaths in the U.S. by 2030. Current guidelines (CAPS, ASGE, NCCN) advise screening only for high-risk individuals such as those with strong family history or genetic mutations.
A new Johns Hopkins Medicine study, published in Gastro Hep Advances (Nov 2025), shows that even mild pancreatic duct dilation (>4 mm) raises the risk of developing high-grade dysplasia or pancreatic cancer. The study tracked 641 high-risk participants and found that individuals with duct widening were more likely to develop cancer earlier. Among 97 individuals with duct enlargement and no mass, 10 developed cancer within a median of two years.
The probability of cancer with baseline duct dilation was 16% at five years and 26% at 10 years. Those with three or more pancreatic cysts were at even higher risk. Experts emphasize that duct dilation should be treated as an immediate red flag even when imaging does not show a visible tumor. Future research aims to use AI to improve risk prediction.
The study was funded by NIH and multiple cancer foundations. Some investigators reported industry relationships; others had no disclosures.
