Intraductal papillary mucinous neoplasm -related pancreatic cancer seems uncommon in patients under 65 years of age

Abstract Purpose Intraductal papillary mucinous neoplasms (IPMNs) are commonly detected incidentally. International guidelines recommend surveillance of branch-duct IPMN (BD-IPMN) in the absence of surgical indications. However, the incidence of IPMN-related cancer in younger populations remains unclear. This study aimed to evaluate the risk of IPMN-related pancreatic cancer (PC) in patients under 65 years of age. Methods The study population consisted of two groups. The first included all patients enrolled in a BD-IPMN surveillance program. The second comprised all patients diagnosed with PC in Pirkanmaa region, Finland, between 2014 and 2023. Demographic data, pancreatic imaging findings, and histological diagnoses were obtained from patient records. Results Of the 574 patients in the BD-IPMN surveillance program, 198 were younger than 65 years. Four patients (2.0%) in this subgroup underwent surgery, and none had PC or high-grade dysplasia (HGD) in surgical specimen or during follow-up imaging before the age of 65. In the PC cohort, 177 patients were diagnosed before age 65 and 540 at age 65 or older. IPMN-related cancer was identified significantly more often in patients aged ≥ 65 years compared to those < 65 years (103 [19.1%] vs. 12 [6.8%], p < 0.001). All patients with PC were symptomatic at diagnosis and had no prior pancreatic imaging. Conclusion BD-IPMN can progress to PC in patients under 65 years of age; however, this appears to be uncommon. Early detection and prevention of IPMN-related cancer in this age group remain challenging and may have limited effectiveness.