Recent-onset diabetes with weight loss linked to increased risk for pancreatic cancer
Recent-onset diabetes accompanied by weight loss appeared to be associated with a substantially higher risk for developing pancreatic cancer, according to results of a retrospective cohort study published in JAMA Oncology.
Factors that further increased this risk included older age, previous healthy weight and no intentional weight loss, researchers noted.
“Pancreatic cancer is the third-leading cause of cancer-related death in the United States, with a 5-year survival rate of less than 10%,” Chen Yuan, ScD, research fellow in medicine at Dana-Farber Cancer Institute, and colleagues wrote. “This low survival rate is largely associated with the diagnosis occurring at an advanced stage when the cancer is no longer curable.”
Individuals who have a strong family history of pancreatic cancer or genetic predisposition to the disease, as well as those with pancreatic cystic lesions, are the primary focus of early detection programs. However, these individuals represent only 15% to 20% of those presenting with pancreatic cancer. Few other high-risk groups have been identified to facilitate screening efforts, but previous studies have identified type 2 diabetes as a risk factor for pancreatic cancer.
Yuan and colleagues sought to determine whether an association existed between diabetes duration and recent weight change and risk for pancreatic cancer among the general population. The researchers analyzed data of 112,818 women (mean age, 59.4 years) in the Nurses’ Health Study and 46,207 men (mean age, 64.7 years) in the Health Professionals Follow-up Study. They identified incident cases of pancreatic cancer from self-reports or during follow-up of participant deaths, verified through reports from next of kin, the U.S. Postal Service or the National Death Index.
Among the study population, researchers identified 1,116 cases of pancreatic cancer during 4.5 million person-years of follow-up.
Results showed participants with recent-onset diabetes had an age-adjusted HR for pancreatic cancer of 2.97 (95% CI, 2.31-3.82), whereas those with long-standing diabetes had an age-adjusted HR of 2.16 (95% CI, 1.78-2.6), compared with participants with no diabetes.
Compared with those who lost no weight, researchers reported age-adjusted HRs for pancreatic cancer of 1.25 (95% CI, 1.03-1.52) for those who reported a 1- to 4-pound weight loss, 1.33 (95% CI, 1.06-1.66) for those with a 5- to 8-pound weight loss, and 1.92 (95% CI, 1.58-2.32) for those with a more than 8-pound loss.
Participants with recent-onset diabetes accompanied by weight loss of 1 to 8 pounds —accounting for 91 incident cases per 100,000 person-years — had an HR for pancreatic cancer of 3.61 (95% CI, 2.14-6.1), whereas those who lost more than 8 pounds — accounting for 164 incident cases per 100,000 person-years — had an HR for pancreatic cancer of 6.75 (95% CI, 4.55-10), compared with those with neither exposure, accounting for 16 incident cases per 100,000 person-years.
Researchers observed higher incidence rates among participants with recent-onset diabetes and weight loss who were aged 70 years or older (234 incident cases per 100,000 person-years), had a BMI 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).
A subset of participants with pancreatic cancer did not return a questionnaire close to the time of cancer diagnosis, which served as a limitation to 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,” Yuan and colleagues wrote. “Further elevation of risk was seen in individuals with older age, previous healthy weight and no intentional weight loss.”
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