ideasIdea
Stop watching stable low-risk pancreatic cysts after five years
Small pancreatic cysts are found on many scans and followed for life. Evidence suggests those unchanged for five years rarely turn to cancer. A stopping rule would spare years of scans.
Low-risk branch-duct IPMN under 2 cm that is stable at five years has very low malignancy rates in Japanese and US cohorts, but guidelines diverge. Propose a randomised trial of surveillance cessation versus continued surveillance for stable low-risk cysts, with pancreatic cancer incidence and imaging burden as endpoints.
Hypothesis
Cessation after five years of stability results in pancreatic cancer incidence under 1% over five further years, non-inferior to continued surveillance.
Rationale
Lifelong surveillance carries cost and anxiety; event rates in stable cysts are low.
What would test it
2,000-patient multicentre RCT.
Maturity
speculative
Who has to act
clinic
Cost to try
Medium ($1M to $50M)
Years to first evidence
6
Bottlenecks it attacks
- Overdiagnosis and false alarms · Finding more cancer is not the same as saving lives. Screening also finds cancers that would never have hurt anyone, and treats them.