Factors Associated with Stage at Diagnosis in Pancreatic Cancer: Implications for Precision Screening and Early Detection

Pancreatic cancer is a leading cause of cancer-related mortality in the United States and worldwide. Most patients are diagnosed with pancreatic cancer at advanced stages, when curative therapy is no longer possible. The stage of pancreatic cancer at diagnosis critically impacts the treatment options and thus the clinical outcomes. Currently, there is no established screening program or tests for its early detection. Studying and understanding how those factors influence the stage of pancreatic cancer at diagnosis helps identify barriers and develop screening strategies. Tumoral and demographic factors, as well as social determinants of health, tend to be associated with localized vs. advanced stage of pancreatic cancer at diagnosis. Socioeconomic factors have been shown to be important mediators of racial disparities in stage at diagnosis as well as germline genetic testing. Recently, screening initiatives, blood-based molecular biomarker tests for early detection of pancreatic cancer, and machine learning-based models for risk prediction and imaging diagnostics have been developed. By determining and understanding the factors associated with the stage at diagnosis, risk-stratified screening can be feasible by combining demographics, genetics, comorbidities, lifestyle, and social determinants. Moreover, regulatory policies that address the social determinants of health can guide the development of screening strategies to allocate resources for equitable access to healthcare and to reduce disparities in patients with pancreatic cancer.