The vast majority of patients with pancreatic ductal adenocarcinoma (PDAC) presents with symptomatic, surgically unresectable disease. While the goal of early detection of PDAC is laudable, and likely to result in significant improvement in overall survival, the relatively low prevalence of PDAC renders general population screening infeasible. The challenges of early detection include identification of at-risk individuals in the general population who would benefit from longitudinal surveillance programs, and appropriate biomarker and imaging-based modalities utilized for PDAC surveillance in such cohorts.