We appreciate the thoughtful comments of Katona and colleagues (1) on our recent work. Regarding pancreatic cancer screening in high-risk patients, we agree screening is a reasonable strategy to improve outcomes in this cohort. As pointed out, for at-risk patients, screening guidelines have been established (2). However, the currently defined high-risk population represents only 5% of patients with pancreatic cancer (3). The central argument of our article is not in the elimination of screening for high-risk individuals, rather that pursuing population-based screening at the expense of research to improve outcomes will not provide an overall benefit due to the low incidence in the population targeted for screening.

Furthermore, the purpose of our analysis was not to debate a specific test's utility, rather to point out that even with a combination of tests offering near perfect (99.9%) specificity, there is significant harm of false-positive tests...

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