Gastroenterology

Gastroenterology

Volume 129, Issue 2, August 2005, Pages 504-511
Gastroenterology

Clinical-liver, pancreas, and biliary tract
Probability of Pancreatic Cancer Following Diabetes: A Population-Based Study

https://doi.org/10.1053/j.gastro.2005.05.007Get rights and content

Background & Aims: Although diabetes occurs frequently in pancreatic cancer, the value of new-onset diabetes as a marker of underlying pancreatic cancer is unknown. Methods: We assembled a population-based cohort of 2122 Rochester, Minnesota, residents age ≥50 years who first met standardized criteria for diabetes between January 1, 1950, and December 31, 1994, and identified those who developed pancreatic cancer within 3 years of meeting criteria for diabetes. We compared observed rates of pancreatic cancer with expected rates based on the Iowa Surveillance Epidemiology and End Results registry. In a nested case control study, we compared body mass index (BMI) and smoking status in diabetes subjects with and without pancreatic cancer. Results: Of 2122 diabetic subjects, 18 (0.85%) were diagnosed with pancreatic cancer within 3 years of meeting criteria for diabetes; 10 of 18 (56%) were diagnosed <6 months after first meeting criteria for diabetes, and 3 were resected. The observed-to-expected ratio of pancreatic cancer in the cohort was 7.94 (95% CI, 4.70–12.55). Compared with subjects without pancreatic cancer, diabetic subjects with pancreatic cancer were more likely to have met diabetes criteria after age 69 (OR = 4.52, 95% CI, 1.61–12.74) years but did not differ significantly with respect to BMI values (29.2 ± 6.8 vs 26.5 ± 5.0, respectively). A larger proportion of those who developed pancreatic cancer were ever smokers (92% vs 69%, respectively), but this did not reach statistical significance. Conclusions: Approximately 1% of diabetes subjects aged ≥50 years will be diagnosed with pancreatic cancer within 3 years of first meeting criteria for diabetes. The usefulness of new-onset diabetes as marker of early pancreatic cancer needs further evaluation.

Section snippets

Patients and Methods

The study was approved by the Mayo Foundation Institutional Review Board (IRB). Population-based studies are possible in Rochester, Minnesota, because essentially all medical care received by local residents is delivered by the Mayo Clinic and the Olmsted Medical Center. Since 1907, every Mayo Clinic patient has been assigned a unique identifier. All information from every contact (including hospital inpatient or outpatient care, office visits, emergency room, and nursing home care, as well as

Results

Between January 1, 1950, and December 31, 1994, there were 2122 Rochester residents ≥50 years of age who first met National Diabetes Data Group (NDDG) criteria for diabetes (male, 50%; mean age, 66.2 ± 10.1 years). Persons were followed to the earliest of pancreatic cancer diagnosis, death, or 3 years, for a total of 5799 person-years of follow-up in the diabetes cohort; during which time, 18 subjects (0.85%) met criteria for pancreatic cancer.

Discussion

In this population-based study, 18 of 2122 (0.85%) diabetes subjects who first met criteria for diabetes ≥50 years of age were identified with pancreatic cancer within 3 years of meeting criteria for diabetes. This represents a 3-year incidence nearly 8 times that for the general population. Forty-four percent of pancreatic cancer subjects in the cohort met criteria for diabetes ≥6 months before the diagnosis of the cancer.

The strengths of the present study are that it was population-based, the

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    Supported by NIH grants R01 CA 100685 (to S.T.C.) and R01 CA 100685 and P20 CA 10270 (to G.M.P. and M.A.), the Lustgarten Foundation (to S.T.C.), and SmithKline Beecham Pharmaceuticals (to C.L.L.).

    The grants and sponsors did not influence design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

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