SMART-Approach Pancreatic Cancer Surveillance in Clinical Practice

Pancreatic ductal adenocarcinoma (PDAC) is a lethal malignancy with over 66,000 new cases in the United States in 2024.(1) The dismal 5-year survival rate of 12% is largely due to late-stage diagnosis.(2) However, early detection rates and improved outcomes may be possible by targeted approaches for high-risk individuals (HRI) with certain genetic and family risk factors for pancreatic cancer.(3-7) This article outlines a practical approach to PDAC surveillance in clinical settings, focusing on identifying and monitoring HRI for early PDAC. We synthesize current recommendations for surveillance (Table 1) and detail lifetime PDAC risk by gene, alongside associated cancers in major hereditary syndromes (Table 2), to guide physicians in optimizing early detection and management strategies.