The concept of pancreatic cancer prevention through surveillance of high-risk patients has come of age. It is cost-effective to provide surveillance of patients who have a lifetime risk of pancreatic cancer that is ≥16%. Studies are currently ongoing that contribute to our understanding of the imaging methodologies that are best suited for surveillance and the best algorithm for the clinical management of patients who are at risk of this highly lethal disease. Long-term outcomes analyses will help shed light on the best management of these patients, as well as a better understanding of the natural history of familial pancreatic cancer.