Abstract PR002: Surveillance-detected pancreatic cancers: Updated report from the PRECEDE Consortium
Raymond Wadlow, Samuel Newton, Jessica Everett, Nandita Rangu, Karen Messer, Jiayu Chen, Randall Brand, Teresa Brentnall, Daniel Chung, Julie Earl, Whitney Espinel, James Farrell, Kurt Giles, Talia Golan, Ora Gordon, John Graff, Aaron Grossberg, Bryson Katona, Richard Kwon, Andrew Lowy, Aimee Lucas, Meg Mandelson, Salvatore Paiella, Elena Stoffel, Margaret Tempero, David Weinberg, Dana Zakalik, George Zogopoulos, Diane M. SimeoneAbstract
Introduction:
The Pancreatic Cancer Early Detection (PRECEDE) Consortium is a multinational prospective longitudinal cohort study of participants with elevated heritable risk for pancreatic adenocarcinoma (PC). PRECEDE aims to support surveillance for high-risk individuals (HRIs) to inform clinical practice and public health policy, with an overarching goal to increase survival of PC by driving early detection. Here we characterize PCs detected in PRECEDE participants to date, with the goal to quantify clinical implications of PC diagnoses within real-world surveillance and early detection programs across the globe.
Methods:
PRECEDE participants (n=12,213) are enrolled at 65 active sites, including 7,337 HRIs meeting NCCN or ASGE criteria for PC surveillance. Those enrolled to surveillance between 5/1/2020 and 7/1/2026 and subsequently diagnosed with PC are included. Standard PRECEDE data include clinical and demographic data, family history, pathogenic germline variants (PGVs), surveillance and diagnostic imaging data, and tumor characteristics from surgical and pathology reports. PC cases beyond Stage 1 are reviewed at an ongoing multi-disciplinary PRECEDE monthly clinical conference.
Results:
52 participants have been diagnosed with PC to date, including 47 with prior imaging (incident PC) and 4 at enrollment (prevalent PC); the most recent case, data pending, is omitted. Of 51 cases, median age at diagnosis was 68 years (range 38-84), 47 (92%) met NCCN or ASGE surveillance guidelines, and 72.5% (37/51) had at least one PGV in a gene linked to PC risk (14 BRCA2, 8 CDKN2A, 7 ATM, 7 BRCA1, 2 CHEK2, 1 APC, 1 MSH2), 3 were in follow up for a pancreatic cystic neoplasm < 1 cm with a single first degree relative with PC, and one for dilated main pancreatic duct with a known PGV in MSH2. Of 21 BRCA1/2 carriers, 9 had no family history of PC. All 4 prevalent PCs had stage III/IV disease. Among 47 incident cases, median years from first surveillance to diagnosis was 3.50 (SD 6.12; range: 0.05 – 30.21), and 31 (66.0%) had stage 0/I disease, with 9 (19.1%) stage II, and 7 (14.9%) stage III/IV. Among 68,538 PC cases in the SEER database, only 11.2% were stage 0/I, a difference of 54.8 percentage points (95% Agresti-Caffo confidence interval for the difference 66.0% vs 11.2%: 40.8%, 67.4%; p < 0.001).
Conclusions:
The proportion of stage 0/1 tumors in incident PRECEDE cases was significantly higher than in SEER population data (66.0% vs 11.2%); however, 14.9% were stage III/IV at diagnosis despite prior normal imaging. Multidisciplinary central review of cases beyond stage 0/1 is underway to investigate potential causes, including missed/delayed surveillance, or missed findings on prior imaging. Whole genome tumor sequencing will also be performed to investigate cases of rapid progression to metastatic disease. Ongoing study of incident PC cases from this longitudinal surveillance population will enable more accurate risk stratification and effective surveillance protocols with the potential for improved rates of early detection.
Citation Format:
Raymond Wadlow, Samuel Newton, Jessica Everett, Nandita Rangu, Karen Messer, Jiayu Chen, Randall Brand, Teresa Brentnall, Daniel Chung, Julie Earl, Whitney Espinel, James Farrell, Kurt Giles, Talia Golan, Ora Gordon, John Graff, Aaron Grossberg, Bryson Katona, Richard Kwon, Andrew Lowy, Aimee Lucas, Meg Mandelson, Salvatore Paiella, Elena Stoffel, Margaret Tempero, David Weinberg, Dana Zakalik, George Zogopoulos, Diane M. Simeone. Surveillance-detected pancreatic cancers: Updated report from the PRECEDE Consortium [abstract]. In: Proceedings of the AACR Conference on Pancreatic Cancer: New Frontiers in Biology and Therapeutic Development; 2026 Sep 25-28; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(18_Suppl_2):Abstract nr PR002.