Pancreatic ductal adenocarcinoma (PDAC) remains a highly lethal disease. The Czech Republic ranks 6th globally in PDAC mortality. This study reports the baseline findings from the first year of a prospective, multicenter surveillance program in the Czech Republic.

In this prospective cohort study, we enrolled asymptomatic high-risk groups with an increased risk of developing pancreatic cancer. These groups included individuals with positive family history of PDAC, hereditary chronic pancreatitis, or confirmed genetic mutations (BRCA1/2, Lynch syndrome, Peutz-Jeghers syndrome, etc.).

Surveillance consisted of annual endoscopic ultrasound (EUS), magnetic resonance imaging (MRI) and blood sampling for analysis of fasting glucose, glycated hemoglobin (HbA1c) and potentially tumor markers (CA 19-9, CEA). The data are subsequently entered into an eCRF and statistically evaluated.

Between 2023 and 2025, a total of 373 high risk individuals (HRIs) were enrolled across nine centres from the Czech Republic (59.2% were female; the mean age was 56 years with range 19 - 80 years). Based on the indication criteria, most HRIs were included due to positive family history of PDAC (264 patients, 70.8%) and BRCA2 positivity (59 patients, 15.8%).

The baseline EUS examination was performed in 316 patients with identifying 108 pathological findings (34.2%). These included 69 cystic lesions (21.8% of all EUS performed), 20 cases of chronic pancreatitis (6.3%) and 4 solid lesions (1.3%). The solid lesions consisted of 1 PDAC and 3 pancreatic neuroendocrine tumors (NETs). Main pancreatic duct dilatation was observed only in 2 cases (0.6%) and other findings in 13 cases (4.1%)- mostly anechogenic lesions.

Baseline MRI/MRCP was performed in 282 patients detecting 58 pathological findings (20.6%), including 41 cystic lesions (14.5%), 8 cases of chronic pancreatitis (2.8%) and other findings in 9 cases (3.2%).

The study demonstrated excellent patient adherence within the long-term surveillance registry. Out of the total cohort of 373 HRIs enrolled across the nine Czech centres, a low number of participants, specifically 10 patients (2.7%), declined further continuation of the follow-up program and were subsequently lost to follow-up.

Baseline data from the HePaCaS registry demonstrate that surveillance in HRIs successfully detected premalignant and malignant lesions, specifically one adenocarcinoma and three neuroendocrine tumors. These findings support the utility of a structured surveillance program, though long-term follow-up is required to confirm survival benefits.