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

Abstract

Objective: 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 6-8-fold, making this group a target of early detection studies. There is also evidence that deteriorating diabetes (DD) may be a risk factor.

Research design and methods: The study prospectively enrolled individuals >50 years with NOD or DD. Participants underwent magnetic resonance imaging/cholangiopancreatography (MRI/MRCP), blood biobanking and anxiety/depression monitoring. MRIs were scored as normal, benign-abnormal, suspicious or incidental finding. Glycemic indices and physician referral patterns were captured.

Results: 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 HbA1c levels (p=0.02), greater weight loss (p=0.0038) and insulin requirements (p<0.0001). 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<0.001).

Conclusions: 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.