Pancreatic Cancer Screening in New-onset and Deteriorating Diabetes: Preliminary Results From the PANDOME Study.

Abstract

Pancreatic cancer (PC) has a high mortality rate due to the lack of early-stage detection strategies and lethality of advanced stage presentations. New-onset diabetes (NOD) in individuals ≥50 years old increases the risk 6- to 8-fold, making this group a target of early detection studies. There is also evidence that deteriorating diabetes (DD) may be a risk factor. The study prospectively enrolled individuals ≥50 years with NOD or DD. Participants underwent magnetic resonance imaging/cholangiopancreatography, blood biobanking and anxiety/depression monitoring. Magnetic resonance imaging scans were scored as normal, benign-abnormal, suspicious, or incidental finding. Glycemic indices and physician referral patterns were captured. Over a 6-year period, 625 individuals were screened and 109 enrolled, 97 (89%) had NOD, and 12 (11%) had DD. Compared to the NOD cohort, the DD cohort was older, had higher hemoglobin A1c levels (P = .02), greater weight loss (P = .0038), and insulin requirements (P < .0001). Four pancreas biopsies were performed for suspicious findings (3.6%), with a stage 1 pancreatic ductal adenocarcinoma identified in the DD group, corresponding to an overall detection rate of 0.9% (1/109). The detection rates of benign pancreatic abnormalities and incidental findings revealed no safety signals. Endocrinologists were the main referral source for the DD cohort (P < .001). Results from the PANDOME study thus far include the first reported screen-detected early-stage PC in a sporadic cohort. Our findings support the inclusion of a DD cohort in prospective PC screening studies in high-risk diabetes. Endocrinologists play an especially important role in the referral of individuals with DD.