What is the role of surveillance for pancreatic cancer in Peutz-Jeghers and BRCA2 carriers?

• A. No surveillance is recommended.
• B. Surveillance may only be CT scans annually.
• C. Surveillance starts at age 70.
• D. Elevated pancreatic cancer risk; surveillance may include annual pancreatic imaging (MRI or EUS) starting at a young adult age.

Answer: (D)

Elevated pancreatic cancer risk in Peutz-Jeghers and BRCA2 carriers makes proactive surveillance essential. Because these individuals have a markedly higher chance of developing pancreatic cancer, the goal is to detect any malignant or premalignant changes as early as possible when treatment is most effective. MRI and endoscopic ultrasound (EUS) are preferred imaging tools because they are highly sensitive for small pancreatic lesions and avoid the radiation exposure associated with CT. Annual imaging provides regular, timely reassessment as risk persists over time. Starting surveillance in young adulthood reflects the need to begin monitoring well before middle age to catch lesions early. The idea that surveillance should be done with annual imaging, using MRI or EUS, starting in young adulthood best captures this approach. In contrast, not surveilling at all, relying only on CT, or delaying until age 70 would miss opportunities for early detection.