Pancreatic ductal adenocarcinoma is projected to become the second leading cause of cancer death in the United States by 2030, according to the National Institutes of Health (NIH). The International Cancer of the Pancreas Screening (CAPS) Consortium, the American Society for Gastrointestinal Endoscopy, and the National Comprehensive Cancer Network currently recommend screening for high-risk individuals, including those with multiple immediate blood relatives who have had pancreatic cancer as well as those identified as having a genetic predisposition. In a new Johns Hopkins Medicine study funded in part by the NIH, researchers found that mild dilatation or enlargement of the pancreatic duct is a risk factor for cancer that should be monitored in high-risk individuals.
The study was published in Gastro Hep Advances in November 2025.
We identify pancreatic ductal dilatation as an early sign of pancreatic cancer in high-risk individuals, even when there is no visible mass. This finding may lead to better survival if cancers are caught early.”
Marcia Irene Canto, MD, MHS, professor of medicine and oncology, Johns Hopkins University School of Medicine
Canto says this research is part of the CAPS study, an ongoing, long-term, prospective cohort study of high-risk individuals with a familial or genetic predisposition to developing pancreatic adenocarcinoma. The study began in 1998. Johns Hopkins Kimmel Cancer is one of the top leaders in pancreatic research and patient care.
In this research, Johns Hopkins Medicine experts evaluated the results of a CAPS cohort of 641 high-risk individuals. During routine follow-up with endoscopic ultrasound and MRI, the researchers measured the participants’ pancreatic ducts and found that patients with a duct diameter greater than 4 millimeters were more likely to have either high dysplasia or cancer. In addition, participants with enlarged pancreatic ducts were more likely to develop cancer early.
Of the 641 participants evaluated, 97 had enlargement without evidence of an obstructive mass lesion. 10 of whom were diagnosed with neoplastic progression within a median of two years after first detection of the dilatation. The cumulative probability of pancreatic cancer with ductal enlargement at baseline was 16% at five years and 26% at 10 years. Participants were 2.6 times more likely to progress to a cancer diagnosis, particularly those with more than three pancreatic cysts during follow-up.
“By identifying this risk factor early, we were able to intervene more quickly,” says Canto. “The intervention would have been either surgery or much more frequent imaging. It was remarkable how, even with the best imaging technology, a pancreatic cancer mass may not be visible even as it causes structural changes in the gland. We have an opportunity to do better.”
Canto says this early warning sign of pancreatic duct dilatation could be a valuable finding that can be identified with other types of diagnostic imaging, such as a CT scan performed for unrelated health issues such as kidney stones or abdominal pain.
“Expansion is a red flag [in high-risk patients]”Providers should be aware that it’s something that needs to be addressed immediately.”
Canto says the next step in research is to use artificial intelligence to analyze imaging and clinical information to make more specific and accurate predictions of risk.
This work was supported by NIH grants U01210170 and R01CA176828. Other sources of funding are Susan Wojcicki and Dennis Troper and a Stand Up to Cancer-Lustgarten Foundation Pancreatic Cancer Interception Translational Cancer Research Grant (Grant Number: SU2CAACR-
DT25-17), sponsored by the American Association for Cancer Research. This work was also supported by the Pancreatic Cancer Action Network, the Rolfe Pancreatic Cancer Foundation, the V Foundation, the Hooven Memorial Fund, the Victor Family Pancreatic Cancer Fund, and the Pancreatic Cancer Hope Foundation.
Other researchers include Elizabeth Abou Diwan, MD, Helena Saba, MD, Amanda L. Blackford, Sc.M., Mohamad Dbouk, MD, Linda Chu, MD, Jin He, MD, Richard Burkhart, MD, Ralph H. Hruban, MD, and Michael Goggins, MD
Canto has received research grants from Pentax Medical Corporation and Merit Medical Corporation. He is a consultant for Castle Biosciences and Clear Note Health and receives royalties from UpToDate. Hruban is eligible to receive royalty payments from Thrive Earlier Detection for the GNAS invention in a relationship overseen by Johns Hopkins University. All other authors have no disclosures.
