406 Risk-Stratified Secondary Surveillance for Individuals in the UK at High Risk of Developing Pancreatic Cancer: Outcomes from the European Registry of Hereditary Pancreatic Diseases (EUROPAC)

Abstract Aim To determine the impact of EUROPAC risk-stratification, which takes account of kinship, family size, age and germline mutations in such predisposed individuals Method Observational study of asymptomatic individuals, prospectively registered with EUROPAC meeting surveillance criteria: endoscopic ultrasound annually with a contrast magnetic resonance image every third year. Results Between January 2000 and April 2025, 900 registered individuals were assessed with 873 being able to take up surveillance, median age of 52 years. 508 individuals (404 pathogenic variant gene mutation negative (PV-ve) and 104 with a PV +ve)) in the 20 years prior to 2020 without stratification were compared to 385 (269 PV -ve and 116 PV +ve) in the 5 years following 2020 who had unique EUROPAC risk-stratification applied. Four (0.8%) individuals had actionable pancreatic findings prior to risk stratification vs. 15 (4%), who underwent risk-stratified surveillance (p=0.001). Operable lesions were found in 3 (0.6%) and 11(3%) p=0.007, respectively with 2 (0.4%) and 9 (2%) being resected, p=0.009. The median (IQR) for time in surveillance prior to a lesion being detected was 4 (2 – 7) years, without significant difference between the groups. Overall, 74% of EUROPAC detected precursor lesions or pancreatic cancers were<stage II. Conclusions The risk-stratified group was 25% smaller than the non-stratified group but showed significant enrichment for important findings, suggesting the key usefulness of risk stratification in targeting secondary surveillance to individuals who will most likely benefit from it.