PANDOME Study Supports Pancreatic Cancer Screening in Diabetics Over 50
USA: Preliminary results from the PANDOME study, published in The Journal of Clinical Endocrinology & Metabolism, have spotlighted deteriorating diabetes (DD) as a significant early warning sign for pancreatic cancer (PC), especially in individuals over the age of 50. Conducted by Dr. Richard C. Frank and colleagues from the Department of Medicine, Division of Hematology/Oncology at Nuvance Health, Norwalk, Connecticut, the study aimed to evaluate the feasibility and utility of screening for pancreatic cancer in high-risk diabetic subgroups.
Pancreatic cancer remains one of the most lethal malignancies, primarily because it often goes undetected until advanced stages. However, earlier studies have shown that people over 50 who develop new-onset diabetes (NOD) have a six-to-eight-fold higher risk of developing pancreatic cancer. In light of emerging data, researchers also considered worsening or deteriorating diabetes, a condition marked by rapid glycemic decline, as a potential predictor of pancreatic cancer.
Over a span of six years, the PANDOME team screened 625 individuals aged over 50, ultimately enrolling 109 participants. Among them, 97 were diagnosed with NOD and 12 with DD. All participants underwent magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP), alongside routine monitoring for psychological well-being, blood biobanking, and documentation of physician referrals and glycemic indicators.
The study revealed the following findings:
- The DD cohort showed more severe clinical features compared to the NOD group.
- Individuals with DD had significantly higher HbA1c levels.
- There was a greater weight loss in the DD group.
- Insulin dependency was more common among those with DD.
- These signs point to a more aggressive pattern of metabolic deterioration in DD patients.
- Endocrinologists were the main source of referrals for individuals in the DD cohort.
- Out of 109 participants, four underwent pancreatic biopsies following suspicious imaging findings.
- One person from the DD group was diagnosed with early-stage pancreatic ductal adenocarcinoma.
- This corresponded to a pancreatic cancer detection rate of 0.9%.
- The imaging procedures did not raise any safety concerns.
- Several benign or incidental pancreatic findings were identified without complications.
This marks the first instance of a screen-detected, early-stage pancreatic cancer case in a sporadic, high-risk cohort. The researchers emphasized that this finding supports including patients with deteriorating diabetes in future screening protocols. By identifying and closely monitoring this subgroup, healthcare providers may have a unique window to detect pancreatic malignancies at a curable stage.
The authors concluded, "The PANDOME study sheds light on a promising strategy for early pancreatic cancer detection by targeting individuals over 50 with newly emerging or worsening diabetes. As the study continues, these initial insights could pave the way for broader, more refined screening efforts aimed at improving survival rates for this deadly disease."
Reference:
Frank, R. C., Shim, B., Lo, T., Pandya, D., Krebs, T. L., Ma, C., Labow, D., Denowitz, J., Anand, N., Krumholtz, P., Sullivan, K., Sanchez, M., Dong, X. E., Seshadri, R., Trinidad, A., & Jin, D. Pancreatic Cancer Screening in New-Onset and Deteriorating Diabetes: Preliminary Results from the PANDOME Study. The Journal of Clinical Endocrinology & Metabolism. https://doi.org/10.1210/clinem/dgaf319
