Caldwell and colleagues (1) highlight several challenges associated with employing a pancreatic cancer screening test. Several questionable assumptions in their study, especially regarding individuals at high risk of pancreatic cancer, limit their conclusions.

First, patients with a positive screening test would not proceed immediately to endoscopic ultrasound/fine-needle aspiration (EUS/FNA). Before clinical implementation, the main causes of false-positive screening tests would need to have been determined. Before broad-scale implementation of a screening test, studies would be undertaken to evaluate strategies to limit complications that arise from aggressively pursuing positive screening tests, such as identifying comorbidities that cause false positives and/or repeating screening tests. Furthermore, a test with 90% specificity would generate too many false positives and would be unlikely implemented for pancreatic cancer screening. If a 99%-specificity test was used, patients testing positive could proceed to EUS, where an FNA, which is the main cause of EUS-related complications, would...

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