Editor’s note: In honor of announcing PanCAN’s Early Detection Initiative, we spoke with Suresh Chari, MD, about the connection between diabetes and pancreatic cancer. Chari is a professor of medicine in the department of gastroenterology at MD Anderson Cancer Center and a member of PanCAN’s Scientific and Medical Advisory Board (SMAB). He was instrumental in the discovery that new-onset diabetes can be an early symptom of pancreatic cancer, and he is the chair of PanCAN’s Early Detection Initiative Steering Committee. Here are six important things to know about diabetes and pancreatic cancer, according to Chari.
- Long-standing diabetes is a (modest) risk factor for pancreatic cancer. Long-standing diabetes can be considered a risk factor for pancreatic cancer. It causes a modest increase in risk of 1.5- to two-fold. Some of the other risk factors for pancreatic cancer include smoking, chronic pancreatitis (inflammation of the pancreas), family history of pancreatic cancer, obesity and certain genetic syndromes.
- The duration of diabetes matters. Individuals who’ve had diabetes for more than five years can be considered at a slightly higher than average risk of developing pancreatic cancer, as noted above. But those with a new onset of diabetes after age 50 have a nearly 1% chance of being diagnosed with pancreatic cancer within three years following their diabetes diagnosis. In this case, the pancreatic tumor caused the diabetes.
- Diabetes is also a symptom of pancreatic cancer. It’s thought that pancreatic cancer can cause cells in the body to become resistant to insulin, a key hormone produced by the pancreas that helps regulate blood sugar levels. In other insulin-resistant conditions (like obesity), the insulin-producing cells in the pancreas make more insulin to overcome the insulin resistance. But pancreatic cancer appears to stop the insulin-producing cells of the pancreas from responding adequately to this insulin resistance. This results in development of diabetes. It’s important to note that even though pancreatic neuroendocrine tumors (PNETs) arise from the hormone-producing cells of the pancreas, diabetes is neither a symptom nor risk factor for PNETs.
- Other clinical factors may identify which people with new-onset diabetes are most likely to have pancreatic cancer. While a new diabetes diagnosis can be an early symptom of pancreatic cancer – and provide an opportunity for early intervention – diabetes is still a much more common disease than pancreatic cancer. Additional clinical criteria are necessary to identify which people with diabetes may have a higher likelihood of having an undiagnosed pancreatic tumor. A scoring system that factors in the individual’s age and changes in their weight and blood sugar has been developed, and these criteria are incorporated into PanCAN’s Early Detection Initiative.
- Diabetes and pancreatic cancer could dramatically benefit from earlier detection. Both diabetes and pancreatic cancer can present with vague symptoms that can be dismissed by doctors and patients, and both can be much more manageable if diagnosed early and accurately. It’s important for researchers and clinicians to develop strategies to make sure all patients are correctly diagnosed as early as possible.
- PanCAN’s Early Detection Initiative and other projects are studying the relationship between diabetes and pancreatic cancer. PanCAN and its donors are investing $25 million in an Early Detection Initiative, which will answer the question of whether abdominal imaging tests at the time of a diabetes diagnosis can lead to earlier detection of pancreatic cancer. The primary goal of the study is to diagnose more patients with pancreatic cancer when the disease can be surgically removed. We will also collect blood samples from participants, which will be pooled with specimens from a National Cancer Institute (NCI)-led study also looking at people with new-onset diabetes. The ultimate aim is to develop a screening approach that will allow doctors to catch pancreatic cancer sooner in a subset of patients.
Watch the video interview with Chari, talking about the relationship between pancreatic cancer and diabetes, and efforts toward pancreatic cancer earlier detection (filmed in November 2017).