This review discusses the early diagnosis of PDAC, focusing on conventional approaches: transabdominal ultrasonography (TUS), endoscopic ultrasound (EUS), endoscopic retrograde cholangiopancreatography (ERCP), computed tomography (CT), and magnetic resonance imaging/magnetic resonance cholangiopancreatography (MRI/MRCP). As such, the Japan Pancreatic Society has demonstrated the diagnostic algorithm of PDAC ( Figure 1) and the risk factors for the disease as a strategic approach to screening high-risk patients of the disease. Efforts have been made to improve the early diagnosis of PDAC. Thus, most cases of PDAC are advanced or metastatic at diagnosis. The detection of PDAC at an early stage has been challenging. PDAC is estimated to become the second-leading cause of cancer-related death by 2030.

The mortality of PDAC has been steadily increasing. The American Cancer Society reported that the number of newly diagnosed patients with PDAC was projected to be about 62,210, and the number of deaths was projected to be 49,830 in the United States in 2022. Pancreatic ductal adenocarcinoma (PDAC) is the fourth-leading cause of cancer-related deaths, and the number of deaths from PDAC will be the second-highest within the next ten years in the United States and it has a dismal prognosis with a 5-year survival rate of less than 10%.

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