DOI: 10.1200/po-26-00955 ISSN: 2473-4284

Longitudinal Pancreatic Imaging Findings in BRCA1 , BRCA2 , ATM, and PALB2

Samantha Kasselman, Jessica M. Long, Tiffiney R. Hartman, Kieran Hawthorne, John J. Graff, Fay Kastrinos, Aimee L. Lucas, Bryson W. Katona, , Todd W. Bauer, Yan Bi, Erkut Borazanci, Randall E. Brand, Teri Brentnall, Darren Carpizo, Daniel C. Chung, Sarah E. Coughlin, Timothy R. Donahue, Beth Dudley, Julie Earl, Jessica N. Everett, James Farrell, Eitan Friedman, Talia Golan, Ora K. Gordon, Robert C. Grant, William Greenhalf, Aaron Grossberg, Zoltán Hajnády, Sigurdís Haraldsdóttir, Philip A. Hart, Peter Hegyi, Melissa E. Hogg, Spring Holter, Gregory E. Idos, Diana Ishak, Vivek Kaul, Kelsey Klute, Sonia S. Kupfer, Kimberly Ku, Richard Kwon, Ido Laish, Rosario J. Ligresti, James L. Lin, Irina Luzko, Whitney Maxwell, James M. McLoughlin, Leticia Moreira, Joanne Ngeow, Salvatore Paiella, Jennifer B. Permuth, Joshua P. Raff, Mitchell L. Ramsey, Nandita Rangu, Kasmintan A. Schrader, Rosalie C. Sears, Brett C. Sheppard, Paul Shin, Diane M. Simeone, Elena M. Stoffel, Daniel A. Sussman, Margaret A. Tempero, Jose G. Trevino, Eva C. Vaquero, Raymond Wadlow, David S. Weinberg, Dana Zakalik, George Zogopoulos
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Purpose

Imaging surveillance for pancreatic cancer (PC) is recommended for select high-risk individuals (HRIs) with a goal of downstaging PC diagnosis and improving long-term survival. A common subgroup of HRIs undergoing PC surveillance imaging includes those with a heterozygous pathogenic germline variant (PGV) in breast cancer susceptibility genes BRCA1 , BRCA2 , ATM , or PALB2. Despite expanding recommendations for PC surveillance imaging in these individuals, limited evidence exists to guide counseling regarding the frequency and longitudinal outcomes of imaging findings.

Methods

The Pancreatic Cancer Early Detection (PRECEDE) Consortium is a prospective multicenter cohort study of HRIs undergoing PC surveillance imaging. In this study, we report imaging outcomes across the first 5 years of enrollment (April 2020-April 2025) for PRECEDE participants with a heterozygous PGV in BRCA1 , BRCA2 , ATM , or PALB2 .

Results

Among 2,085 eligible participants, PGVs in BRCA2 (51%) were most common, followed by BRCA1 (21%), ATM (19%), and PALB2 (9%). Baseline pancreatic imaging occurred primarily with endoscopic ultrasound (EUS; 55%) or magnetic resonance imaging (43%). More than half (54%) of the participants had at least 1 pancreatic imaging finding during the study, while concerning findings including worrisome cysts, main pancreatic duct dilation ≥5 mm, and solid masses were detected in 9.1% of the cohort. Among HRIs without a pancreatic cyst or solid mass at baseline imaging, 71% remained without findings after at least two follow-ups. Additionally, 87% of HRIs with pancreatic cysts and follow-up imaging using the same modality did not have worrisome cyst growth.

Conclusion

In this largest reported cohort of BRCA1 , BRCA2 , ATM , and PALB2 heterozygotes undergoing PC surveillance imaging, benign/low-risk pancreatic imaging findings were common and stable on short-term follow-up, providing important data for counseling these HRIs.

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