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Late-onset diabetes may be early sign of pancreatic cancer among African-Americans, Latinos
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African-Americans and Latinos with diabetes had a twofold increased risk for pancreatic cancer, according to study findings published in Journal of the National Cancer Institute.
Recent-onset diabetes was associated with greater pancreatic cancer risk among these groups than long-standing diabetes, research showed.
“What we found is that, yes, diabetes is associated with pancreatic cancer in African-Americans and Latinos, but we also discovered that there is a different type of diabetes here, a late-onset diabetes that’s associated with developing pancreatic cancer within 36 months,” Veronica Wendy Setiawan, PhD, associate professor of preventive medicine at Keck School of Medicine of USC, said in a press release. “The evidence suggests that late-onset diabetes may be an early sign of pancreatic cancer.”
Individuals with pancreatic cancer have poor prognosis — with a 5-year OS rate of 8% — mostly due to late stage of disease at diagnosis.
“Identifying people who are at high risk early on could potentially save their lives,” Setiawan said.
Previous studies have indicated individuals with recent-onset diabetes have higher risk for pancreatic cancer than those with long-standing diabetes.
African-Americans have the highest incidence rate for pancreatic cancer in the U.S., whereas incidence among Latinos is relatively low. Both African-Americans and Latinos are at increased risk for developing diabetes.
The relationship between recent-onset diabetes and pancreatic cancer incidence among U.S. minorities has not been evaluated in population-based prospective studies.
“There are very few studies on diabetes and pancreatic cancer that include Latinos and African-Americans,” Setiawan said in the release. “Both groups have a high rate of diabetes and African-Americans, in particular, have a higher risk [for] developing pancreatic cancer relative to other racial/ethnic groups.”
Researchers evaluated the relationship between recent-onset diabetes and pancreatic cancer incidence among African-Americans and Latinos enrolled in the Multiethnic Cohort Study — an ongoing, population-based, prospective cohort study with more than 215,000 men and women from Hawaii and California.
Investigators reviewed data of 48,995 individuals aged 45 to 75 years — 20,403 African-Americans and 28,592 Latinos — from California who did not have prior diabetes and cancer at the time of enrollment in the Multiethnic Cohort Study (1993-1996). Researchers used patient questionnaires, Medicare data and California hospital discharge files to identify diabetes diagnoses.
Recent-onset diabetes was defined as occurring within 3 years of pancreatic cancer diagnosis.
Nearly one-third (32.3%) of individuals developed diabetes between 1993-1996 and 2013. Individuals diagnosed with diabetes had higher BMI at baseline than individuals who did not develop diabetes.
During an average follow-up of 14 years, 128 individuals with incident diabetes developed pancreatic cancer (age-adjusted incidence rate = 72.3 per 100,000). Among individuals without incident diabetes, 280 developed pancreatic cancer (age-adjusted incidence rate = 36 per 100,000).
Median age at pancreatic cancer diagnosis was 76.7 years (range, 55.3-92.3).
Diabetes was more common among individuals who developed pancreatic cancer (31.4%) than among individuals who developed colorectal cancer (16.4%), breast cancer (14.5%) or prostate cancer (11.7%; P < .001 for all). The presence of recent-onset diabetes also appeared higher among individuals who developed pancreatic cancer (16.4%) than those with colorectal (6.7%), breast (5.3%) or prostate (5.5%; P < .001 for all) cancer.
Diabetes developed in the 36 months preceding pancreatic cancer diagnosis among 52.3% of individuals with both diseases. The median duration of diabetes among individuals with pancreatic cancer was 34.4 months (range, 0.07-193.4).
Diabetes appeared associated with pancreatic cancer at age 65 years (HR = 4.6; 95% CI, 3-7.05) and age 75 years (HR = 2.39; 95% CI, 1.91-2.98). Age 75 years was the closest median age of pancreatic cancer diagnosis; at this age, the association for pancreatic cancer with recent-onset diabetes was 2.3-fold greater (HR = 3.71; 95% CI, 2.83-4.88) than with long-standing diabetes (HR = 1.61; 95% CI, 1.18-2.21).
The HRs for pancreatic cancer at age 75 years with recent-onset diabetes was 4.08 (95% CI, 2.76-6.03) among Latinos and 3.38 (95% CI, 2.30-4.98) among African-Americans.
“Pancreatic cancer is a rare disease, but if you are diagnosed with late-onset diabetes, have a conversation with your clinician about your individual risk,” Setiawan said. “Early intervention could improve survival.” – by Melinda Stevens
Disclosures: The NCI supported this study. Setiawan reports support from an American Cancer Society research scholar grant. Please see the study for all other author’s relevant financial disclosures.
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