Diabetes and Subsequent Weight Loss Linked to an Increased Risk of Pancreatic Cancer 

The case for expanding screening for pancreatic cancer in those with new onset of diabetes and weight loss. 

Pancreatic cancer is a major cause of cancer-related deaths worldwide due to a lack of effective screening and resistance to chemotherapy. It is also difficult to diagnose during the early stages due to the lack of distinct symptoms. Symptoms associated with pancreatic cancer typically include weight loss, fatigue, jaundice, abdominal pain, and nausea and can be associated with many other conditions. The location of the pancreas also makes it difficult for physicians to see during routine physical exams. Therefore, diagnosis is generally made at advanced stages when it has already affected other organs such as the lungs, liver, and lymph nodes. Pancreatic cancer is commonly known as Pancreatic Ductal Adenocarcinoma. There is a 5-year survival rate in the United States. Unfortunately, no screening test has been shown to lower the risk of dying from this cancer. However, radiologists, gastroenterologists, surgeons, pathologists, and genetic counselors work together to find new tests to detect pancreatic cancer early. Currently, the most common tests used are endoscopic ultrasound or MRI. 

A high body mass index or obesity has been associated with pancreatic cancer for many years. Diabetes, along with weight changes, has recently been associated with an increased risk of pancreatic cancer. For this study, data from the Nurses’ Health Study and the Health Professionals Follow-Up Study were used. The data consisted of decades of medical history.  One hundred twelve thousand eight hundred eighteen women with a mean age of 59 years were included in the Nurses’ Health Study group, and 46,207 men with a mean age of 65 years were included in the Health Professionals Follow-Up Study group. A total of 1,116 cases of pancreatic cancer were identified amongst the entire study population. 

Patients with no diabetes were compared to patients with recent-onset diabetes during this study. Patients with recent-onset diabetes had triple the risk of pancreatic cancer. The study also included a comparison of the patients’ weight loss. Patients with reported weight loss had a higher risk of pancreatic cancer than patients who didn’t experience weight loss. Ultimately, patients with recent-onset diabetes and a 1- to 8-pound weight loss had a much higher incidence of pancreatic cancer than patients with neither. There were 16 cases per 100,000 persons. The mean age at diagnosis of pancreas cancer in individuals with familial pancreas cancer is 68 years of age. This age group also correlates with results from the study that showed that in patients with both recent-onset diabetes and weight loss, rates of pancreatic cancer were also notably high in those 70 years or older. 

This study concluded that early screening for pancreatic cancer could be beneficial for patients with the onset of diabetes and weight loss. Testing for pancreatic cancer is generally considered for people in families at high risk of pancreatic cancer or a known genetic syndrome that increases their risk. Testing is not considered in normal populations, and average-risk individuals do not warrant screening for pancreatic cancer. After reviewing results from this study, patients with the onset of diabetes and weight loss should be considered for regular testing for pancreatic cancer, considering that they also have increased risk for this disease. In 2019, approximately 56,770 people were diagnosed with pancreas cancer, and 45,750 died of the disease. There should be changes to the screening guidelines for pancreatic cancer to prevent future cases and decrease mortality rates.  

Practice Pearls: 

• Lack of effective screening and resistance to chemotherapy contributes to pancreatic cancer, the third leading cause of cancer-related death.  
• Testing for pancreatic cancer is usually considered for people in families at high risk of pancreatic cancer or a known genetic syndrome that increases their risk. 
• Modifications to the screening guidelines for pancreatic cancer should be made to prevent future cases and decrease mortality rates. 

Yuan C, Babic A, Diabetes, Weight Change, and Pancreatic Cancer Risk. JAMA Oncol. August 13, 2020. doi:10.1001/jamaoncol.2020.2948 

Majumder S, Chari ST, Ahlquist DA. Molecular detection of pancreatic neoplasia: Current status and future promise. World J Gastroenterol.  

Destiny Funchess, PharmD Candidate, Tougaloo College, South College School of Pharmacy