Recent-onset diabetes in the setting of unintentional weight loss was significantly associated with a diagnosis of pancreatic cancer, according to results of a large cohort study published in JAMA Oncology.1
Pancreatic cancer is most commonly diagnosed following disease metastasis, and the prognosis for patients with stage IV pancreatic cancer is poor.
Outcomes of programs focused on imaging-based screening for the early detection of pancreatic cancer in persons with known risk factors for the disease, such as a strong family history or the presence of genetic risk factors, appear promising; however, guidelines from the US Preventive Services Task Force recommend against pancreatic cancer screening in asymptomatic persons considered to be at average risk for the disease.2 Hence, there is a need to identify other factors associated with a high risk of developing pancreatic cancer.
Based on the results of previous studies, diabetes is known to develop in the setting of pancreatic cancer, and to be associated with weight loss.
Furthermore, patients presenting with this form of diabetes, termed pancreatogenic diabetes, are more likely than other patients with the disease to have resectable tumors; hence, it represents a potential marker for identifying patients appropriate for pancreatic cancer screening.
“Nonetheless, the risks for pancreatic cancer associated with different duration of diabetes and degree of weight loss have not been evaluated in the general population,” the study authors noted.
This large cohort study included 112,818 women from the Nurses Health Study (NHS) with a baseline date of 1978, and 46,207 men from the Health Professional Follow-Up Study (HPFS) with a baseline date of 1988.
Both studies included biennial updates regarding patient demographic characteristics, lifestyle characteristics, and medical history, and none of these patients had prevalent diabetes or a history of cancer at baseline. Weight change with respect to pancreatic cancer diagnosis was assessed according to patient weights included in questionnaires completed at a median of 1 year and 3 years prior to diagnosis of pancreatic cancer.
Some key findings of this study include:
- In comparison with study participants without diabetes, the age-adjusted hazard ratios (HRs) for pancreatic cancer were 2.97 (95% CI, 2.31-3.82) and 2.16 (95% CI, 1.78-2.60) for those with recent-onset and long-standing diabetes, respectively.
- In comparison with study participants without weight loss, the age-adjusted HRs for pancreatic cancer were 1.25 (95% CI, 1.03-1.52) for those with a weight loss of 1 to 4 pounds, 1.33 (95% CI, 1.06-1.66) for those with a weight loss of 5 to 8 pounds, and 1.92 (95% CI, 1.58-2.32) for those with a weight loss of more than 8 pounds.
- In comparison with study participants without recent-onset diabetes or a weight loss, the age-adjusted HRs for pancreatic cancer were 3.61 (95% CI, 2.14-6.10) for those with recent-onset diabetes and a weight loss of 1 to 8 pounds, and 6.75 (95% CI, 4.55-10.00) for those with recent-onset diabetes and a weight loss of 8 pounds or more.
- Pancreatic cancer risk was found to be even higher for those with recent-onset diabetes who were characterized by older age, healthy weight prior to weight loss, and unintentional weight loss.
“In this study, recent-onset diabetes accompanied by weight loss was associated with a substantial increase in risk for pancreatic cancer and may represent a high-risk group in the general population for whom early detection strategies would be advantageous,” the study authors commented in their concluding remarks.
1. Yuan C, Babic A, Khalaf N, et al. Diabetes, weight change, and pancreatic cancer risk. JAMA Oncol. Published online August 13, 2020. doi: 10.1001/jamaoncol.2020.2948
2. US Preventive Services Task Force. Screening for pancreatic cancer: US Preventive Services Task Force reaffirmation recommendation statement. JAMA. 2019;322(5):438-444. doi:10.1001/jama.2019.10232