Pancreatic Cancer Screening in New-onset and Deteriorating Diabetes: Preliminary Results From the PANDOME Study
Richard C. Frank, Brian Shim, Tammy Lo, Deep Pandya, Thorsten Krebs, Marie‐Aline Charles, Daniel M. Labow, Jill Denowitz, Naveen Anand, Pramila Krumholtz, Kiyoe Sullivan, Mark Sanchez, Xiang Da Dong, Ramanathan Seshadri, Antolin C. Trinidad, Dugho Jin
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- 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. RESEARCH DESIGN AND METHODS: 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. 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 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). CONCLUSION: 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.