Diabetes Deterioration May Signal Hidden Cancer
MRI screening shows promise for early detection of pancreatic tumors in high-risk patients.
For individuals over 50, the emergence of new diabetes or a worsening of existing diabetes could indicate a hidden risk: pancreatic cancer. A recent study suggests MRI screenings could help detect these cancers early.
MRI Screening Uncovers Stage IB Pancreatic Cancer
The PANDOME study, led by **Richard Frank**, MD, explored the effectiveness of MRI-based screening for early pancreatic cancer detection in patients with new-onset diabetes or deteriorating diabetes. The research involved 97 patients with new-onset diabetes and 12 with deteriorating diabetes.
Those with deteriorating diabetes displayed significantly higher A1c levels, greater weight loss, and increased insulin needs, in comparison to the new-onset group.
Study Details
New-onset diabetes was defined as elevated A1c levels within the past year. Deteriorating diabetes meant long-standing diabetes (over two years) with a significant A1c increase (more than 2%) in the last six months, unrelated to weight changes or medication adherence.
All participants underwent MRI/cholangiopancreatography, blood biobanking, and monitoring for anxiety/depression. MRI results were categorized as normal, benign-abnormal, suspicious, or incidental findings.
Key Findings on Cancer Risk
Among the participants, over half had small cystic lesions, averaging 6 mm. This led to seven endoscopic ultrasound procedures, with four biopsies performed. One biopsy revealed stage IB pancreatic ductal adenocarcinoma in a patient with deteriorating diabetes.
Notably, 75% of the deteriorating diabetes group had high-risk scores for pancreatic cancer, compared to 35.6% in the new-onset diabetes group, according to the Enriching New-Onset Diabetes for Pancreatic Cancer score.
Incidental Findings
The study also uncovered extra-pancreatic incidental findings in 8.2% of cases. Two biopsies revealed a new diagnosis of follicular lymphoma and a recurrence of lymphoma, respectively.
Study Limitations
The study had some limitations including low accrual rates and potential selection bias. Most participants were referred, which may have affected detection rates. Also, the predominantly White participant pool limits the generalizability of the findings, given higher pancreatic cancer risk among Black populations.
Clinical Significance
The study, published in The Journal of Clinical Endocrinology & Metabolism, suggests that “Preliminary results from the PANDOME study support further MRI-based PC [pancreatic cancer] screening research efforts in individuals with NOD [new-onset diabetes] and DD [deteriorating diabetes].”
According to the American Cancer Society, about 66,440 people will be diagnosed with pancreatic cancer in the U.S. in 2024, and about 51,750 people will die of it (American Cancer Society).
Funding and Disclosures
The study was funded by several organizations, including a Tribute to Pamela/The Naughton Family Fund. The authors reported no conflicts of interest.