Diabetes with weight loss tied to increased pancreatic cancer risk: JAMA

Older age, previous healthy weight, and no intentional weight loss further elevate this risk, suggests the study recently published in JAMA Oncology.

Pancreatic cancer is the third-leading cause of cancer-related death in the United States, with a very low cure rate.Because of the poor prognosis in late stages, the US Preventive Services Task Force recommends against pancreatic cancer screening for asymptomatic individuals with average risk.

It has been well documented that, type 2 diabetes as a major risk factor for pancreatic cancer. Although type 2 diabetes is often accompanied by weight gain, pancreatogenic diabetes can paradoxically be accompanied by weight loss. Furthermore, whether metrics of weight loss intentionality are associated with the accuracy of pancreatic cancer risk prediction has not been assessed.

To find an answer to the existing gaps in present knowledge on this topic, Chen Yuan and team undertook a study to evaluate the association of diabetes duration and recent weight change with subsequent risk of pancreatic cancer in the general population.

This cohort study obtained data from female participants in the Nurses' Health Study and male participants in the Health Professionals Follow-Up Study, with repeated exposure assessments over 30 years. Incident cases of pancreatic cancer were identified from self-report or during follow-up of participant deaths. Deaths were ascertained through reports from the next of kin, the US Postal Service, or the National Death Index.

An extensive detailed result was provided in the study report. The main highlights are as follows.

• Of the 112 818 women (with a mean [SD] age of 59.4 [11.7] years) and 46 207 men (with a mean [SD] age of 64.7 [10.8] years) included in the analysis, 1116 incident cases of pancreatic cancers were identified.
• Compared with participants with no diabetes, those with recent-onset diabetes had an age-adjusted HR for pancreatic cancer of 2.97 (95% CI, 2.31-3.82) and those with long-standing diabetes had an age-adjusted HR of 2.16 (95% CI, 1.78-2.60).
• Compared with those with no weight loss, participants who reported a 1- to 4-lb weight loss had an age-adjusted HR for pancreatic cancer of 1.25 (95% CI, 1.03-1.52), those with a 5- to 8-lb weight loss had an age-adjusted HR of 1.33 (95% CI, 1.06-1.66), and those with more than an 8-lb weight loss had an age-adjusted HR of 1.92 (95% CI, 1.58-2.32).
• Participants with recent-onset diabetes accompanied by weight loss of 1 to 8 lb (91 incident cases per 100 000 person-years [95% CI, 55-151]; HR, 3.61 [95% CI, 2.14-6.10]) or more than 8 lb (164 incident cases per 100 000 person-years [95% CI, 114-238]; HR, 6.75 [95% CI, 4.55-10.00]) had a substantially increased risk for pancreatic cancer compared with those with neither exposure (16 incident cases per 100 000 person-years; 95% CI, 14-17).
• Incidence rates were even higher among participants with recent-onset diabetes and weight loss with a body mass index of less than 25 before weight loss (400 incident cases per 100 000 person-years) or whose weight loss was not intentional judging from increased physical activity or healthier dietary choices (334 incident cases per 100 000 person-years).

"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." concluded the authors.

For full article click in the link: DOI:10.1001/jamaoncol.2020.2948

Primary source: JAMA Oncology