On the occasion of World Cancer Day on 4 February, we spoke with Professor Roland Andersson, Professor of Surgery at Lund University, Sweden, about his decades-long work in pancreatic cancer and his role in the SHIELD project. With nearly 40 years of experience as a surgeon and researcher, Professor Andersson has been at the forefront of clinical and translational research aimed at improving outcomes for one of the deadliest forms of cancer.
Professor Roland Andersson is a surgeon and researcher who has devoted close to four decades to pancreatic cancer. His work has spanned clinical care and research, building a comprehensive surgical service for southern Sweden alongside strong translational research activities. Over the years, this commitment has led to an extensive international network and active involvement in major professional societies related to pancreatic cancer, including board positions in the International Hepato-Pancreato-Biliary Association (IHPBA), its European-African branch (E-AHPBA), and as founder and president of the Nordic HPB association. His career includes the supervision of around 35 PhD students and authorship of approximately 600 scientific publications, reviews, and book chapters.
A major focus of Professor Andersson’s research, together with his research groups, has been the improvement of early diagnosis of pancreatic cancer. Early detection is one of the key avenues to improving patient outcomes in this disease. This work led to the identification of a new panel of protein-based biomarkers in serum. To enable further development of this biomarker panel toward clinical implementation, he founded Reccan AB with early support from Lund University. Today, pancreatic cancer research continues both within academia and through Reccan, where Professor Andersson serves as Chairman of the Board and Clinical Scientific Officer.
Given that the SHIELD project is built on research originating from Lund and uses the Reccan-IA immunoassay, his role as clinical coordinator of the study was a natural progression of this work.
The SHIELD project is designed to evaluate the clinical performance of the Reccan-IA test in detecting pancreatic ductal adenocarcinoma (PDAC) in individuals with familial and genetic high risk. The project encompasses strategies to identify high-risk individuals and assess eligibility, the development and execution of a pilot surveillance programme, validation of the clinical performance of the Reccan-IA test, and genetic testing. In total, SHIELD brings together 26 institutions, including seven clinical study sites, across 13 European countries. Structured as a consortium, the project includes all partners necessary to carry out the study from clinical validation to dissemination, upscaling, and exploitation.
SHIELD is funded by Horizon Europe and is specifically directed at the early diagnosis of pancreatic cancer in risk groups, focusing on familial and hereditary cases. According to Professor Andersson, this funding significantly accelerates the development of one of the most critical and urgently needed strategies to improve outcomes in pancreatic cancer.
Pancreatic cancer, most commonly referring to pancreatic ductal adenocarcinoma, is associated with an exceptionally poor prognosis. Because symptoms are often vague, the disease is usually diagnosed at a late stage, when it is already locally advanced or metastatic. Approximately 85% of patients are diagnosed with inoperable disease and can only receive palliative treatment. While reported five-year survival rates have reached up to 10% in some studies, more recent data suggest that the true five-year survival in PDAC is closer to 5%. Despite advances in surgery and the introduction of chemotherapy in both adjuvant and palliative settings, overall improvements in survival have been marginal.
PDAC remains the most lethal type of cancer, even though it is relatively infrequent, ranking around 11th to 14th among cancers. Due to its high mortality, it is projected that by 2030 it could become the second leading cause of cancer-related death. In addition to its human cost, PDAC places substantial demands on healthcare resources and is associated with high overall costs.
The development of PDAC is often a long process, potentially spanning a decade from the first mutation, but it remains asymptomatic until the final phase of exponential tumour growth. Detecting the disease just six to twelve months earlier could substantially increase the proportion of patients eligible for surgical resection. When PDAC is identified at early, resectable stages (stage I–II), five-year survival rates of up to 50% have been reported.
There are several known risk groups for developing PDAC. These include individuals with new-onset type II diabetes above the age of 50, certain cystic lesions of the pancreas-especially main duct intraductal papillary mucinous neoplasms (IPMN)-and individuals with hereditary or familial risk, often linked to known genetic mutations. The hereditary and familial group accounts for around 10% of all PDAC cases and, when identified, is often enrolled in surveillance programmes. This group is the primary focus of the SHIELD project.
Current diagnostic approaches have clear limitations. The standard blood biomarker, CA 19-9, has been used for around 40 years but lacks sufficient sensitivity and specificity, is influenced by inflammation and jaundice, and is not expressed by all individuals. Imaging techniques such as computed tomography and magnetic resonance imaging may also struggle to detect very small lesions under 5–10 mm. As a result, annual surveillance using current tools may allow an undetected cancer to progress to an inoperable stage before it is identified, eliminating the possibility of cure.
Within SHIELD, the Reccan-IA immunoassay is used as a blood-based protein biomarker panel derived from serum. The panel reflects multiple aspects of PDAC, including tumour growth, metastatic potential, and inflammation. In comparisons involving 450 patients with resectable PDAC and healthy controls, the test outperformed CA 19-9, achieving an overall sensitivity of 91.5%, a specificity of 96.8%, and an area under the curve (AUC) of 0.98. Sensitivity for detecting early-stage cancers was 87.8%, and the test detected 76% of cancers in which CA 19-9 levels were below the detection threshold. This test will now be validated within the SHIELD study.
Clinical validation of the Reccan-IA test will take place at seven clinical sites across Europe. As part of this effort, a recruitment platform will be established to implement a surveillance programme for early detection of pancreatic cancer in individuals with hereditary or familial risk. The aim is to reach more than 5,000 individuals, offer genetic testing to 3,000 of them, and include at least 1,000 individuals in an annual surveillance programme.
High-risk individuals will be identified primarily within hospitals, which is considered the most effective initial recruitment strategy, and through targeted outreach and public campaigns. In addition to validating the blood test, the SHIELD project also includes an evaluation of cost-effectiveness.
If validation confirms improved detection and favourable health-economic outcomes, the test can be integrated into screening programmes for high-risk PDAC groups. Dissemination will take place through presentations at scientific meetings, peer-reviewed publications, engagement with professional and patient organisations, awareness-raising among key opinion leaders, and inclusion in updated clinical guidelines and recommendations. Due to the relative infrequency of PDAC, general population screening is not considered realistic.
Looking ahead, Professor Andersson emphasises that the long-term impact of SHIELD lies in the successful establishment of an effective surveillance programme for high-risk individuals and the validation of a robust blood test for early detection. Together, these achievements have the potential to improve European standards for surveillance and significantly enhance outcomes through earlier diagnosis of pancreatic ductal adenocarcinoma. Where possible, findings will be incorporated into guidelines and recommendations. In the shorter term, the SHIELD consortium itself fosters collaboration across disciplines, patient organisations, and national screening authorities, adding broader value to healthcare management and innovation.