In a retrospective review of prior negative MRI findings for carriers of germline CDKN2A pathogenic variants who developed PDAC, mild pancreatic ductal dilatation was an unrecognized subtle abnormality. Nonetheless, nearly one-half of high-risk individuals who developed neoplastic progression while under surveillance had no prior pancreatic lesions detected by imaging studies. In addition, the psychological burden of annual surveillance of high-risk individuals should be considered, but it appears to be low, and surveillance may be associated with decreased cancer worry after initiating it. The gene discussed is CDKN2A; the disease is cancer.