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 surveillance for high-risk individuals, including individuals 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 mild dilatation, or enlargement, of the pancreatic duct is a cancer risk factor that should be monitored in high-risk individuals.
The study was published in Gastro Hep Advances in November 2025.
"We are identifying pancreas duct 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 detected early," says Marcia Irene Canto, M.D., M.H.S., a professor of medicine and oncology at the Johns Hopkins University School of Medicine.
Canto says this investigation is part of the CAPS Study, an ongoing, long-term, prospective cohort study of high-risk individuals with a familial or genetic predisposition for developing pancreatic adenocarcinoma. The study was initiated in 1998. Johns Hopkins Kimmel Cancer is one of the foremost leaders in pancreatic research and patient care.
In this research, Johns Hopkins Medicine experts evaluated the outcomes of a CAPS cohort of 641 high-risk individuals. During routine surveillance with endoscopic ultrasound and MRI, the researchers measured the participants' pancreatic ducts and found that in patients with a duct diameter greater than 4 millimeters, the chances of developing either high-grade dysplasia or cancer increased. Moreover, participants with widened pancreatic ducts were more likely to develop cancer early.
Of the 641 participants evaluated, 97 showed enlargement without evidence of an obstructing mass lesion; 10 of whom were diagnosed with neoplastic progression within a median of two years after dilatation was first detected. The cumulative probability of pancreatic cancer with baseline duct widening 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 surveillance.
"By identifying this risk factor early, we were able to intervene more quickly," says Canto. "The intervention would be to either operate or do much more frequent imaging. It was remarkable how even with the best imaging technology, a pancreatic cancer mass may not be visible even when it is causing structural changes in the gland. We have an opportunity to do better."
Canto says this early warning sign of pancreatic duct dilation could be a valuable finding identifiable with other kinds of diagnostic imaging, such as CT performed for unrelated health issues like kidney stones or abdominal pain.
"The dilatation is a red flag [in high-risk patients]," Canto says. "Providers should be aware that it is something that needs to be addressed right away."
Canto says the next step in the research is using 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 funding sources 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), administered 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, M.D., Helena Saba, M.D., Amanda L. Blackford, Sc.M., Mohamad Dbouk, M.D., Linda Chu, M.D., Jin He, M.D., Richard Burkhart, M.D., Ralph H. Hruban, M.D., and Michael Goggins, M.D.
Canto received research grants from Pentax Medical Corporation and Merit Medical Corporation. She is a consultant for Castle Biosciences and Clear Note Health, and receives royalties from UpToDate. Hruban has the potential to receive royalty payments from Thrive Earlier Detection for the GNAS invention in a relationship overseen by The Johns Hopkins University. All other authors have no disclosures.
