Should pancreas imaging be recommanded in patients over 50 years when diabetes is discovered because of acute symptoms?

Damiano, J.; Bordier, L.; Berre, JP Le; Margery, J.; Dupuy, O.; Mayaudon, H.; Bauduceau, B.

doi:10.1016/s1262-3636(07)70111-8

Cited by 51 publications

(36 citation statements)

References 18 publications

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“…The poor rate of resectability in all these studies shows that the strategy to use symptoms such as jaundice and anorexia as clues to suspect pancreatic cancer in new-onset diabetes is unlikely to detect resectable cancer because these symptoms generally are associated with unresectable pancreatic cancer. 38,39 Studies in which early and resectable cancers have been screened for hyperglycemia show that glucose intolerance occurs at an early stage of pancreatic cancer and is not dependent on size of tumor or stage of disease. Tsuchiya et al 41 reported that 48 of 79 (60.8%) patients with small pancreatic cancers (<20 mm in size) had abnormal glucose tolerance.…”

Section: Discussionmentioning

confidence: 99%

Probability of Pancreatic Cancer Following Diabetes: A Population-Based Study

et al. 2005

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Section: Discussionmentioning

confidence: 99%

Probability of Pancreatic Cancer Following Diabetes: A Population-Based Study

et al. 2005

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“…The problem is that newonset DM, per se, is not a powerful-enough predictor of PC to stand alone as an indication for radiological or endoscopic screening, as 98% of patients with adult-onset DM will never develop PC (Chari et al 2005a). Imaging protocols applied to patients with new-onset DM older than the age of 50 have not been shown to be either practical or reliable as an early detection method based on the studies in Japan (Ogawa et al 2002), France (Damiano et al 2004), and the USA (Chari et al 2005a,b).…”

Section: Diabetes As a Consequence (And Harbinger) Of Pc The Prevalenmentioning

confidence: 99%

Diabetes and pancreatic cancer

Cui¹,

Andersen²

2012

Endocrine-Related Cancer

131

102

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Epidemiological studies clearly indicate that the risk of pancreatic cancer (PC) is increased in diabetic patients, but most studies focus on overall diabetes or type 2 diabetes mellitus (T2DM), and there are few studies on the risks of type 1 and type 3c (secondary) diabetes. Possible mechanisms for increased cancer risk in diabetes include cellular proliferative effects of hyperglycemia, hyperinsulinemia, and abnormalities in insulin/IGF receptor pathways. Recently, insulin and insulin secretagogues have been observed to increase the PC risk, while metformin treatment reduces the cancer risk in diabetic subjects. In addition, anticancer drugs used to treat PC may either cause diabetes or worsen coexisting diabetes. T3cDM has emerged as a major subset of diabetes and may have the highest risk of pancreatic carcinoma especially in patients with chronic pancreatitis. T3cDM is also a consequence of PC in at least 30% of patients. Distinguishing T3cDM from the more prevalent T2DM among new-onset diabetic patients can be aided by an assessment of clinical features and confirmed by finding a deficiency in postprandial pancreatic polypeptide release. In conclusion, diabetes and PC have a complex relationship that requires more clinical attention. The risk of developing PC can be reduced by aggressive prevention and treatment of T2DM and obesity and the prompt diagnosis of T3cDM may allow detection of a tumor at a potentially curable stage.

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“…In this study 1 in 125 subjects with new-onset diabetes had pancreatic cancer. Recent studies (53,54) show an even higher prevalence of pancreatic cancer in subjects with new-onset diabetes (5.2 to 13.6%) as they targeted selected high-risk subjects with recently diagnosed diabetes. These studies and the earlier epidemiologic studies suggest that subjects with newonset diabetes are a high-risk group for having pancreatic cancer.…”

Section: B) New-onset Diabetes Defines a High-risk Group For Pancreatmentioning

confidence: 99%

“…In studies on prevalence of cancer in new-onset diabetes, patients with physician diagnosed diabetes were investigated for cancer mostly after development of cancer symptoms. The poor rate of resectability in all these studies shows that the strategy to use symptoms such as jaundice and anorexia as clues to suspect pancreatic cancer in new-onset diabetes is unlikely to detect resectable cancer as these symptoms are generally associated with unresectable pancreatic cancer (53,54) On the other hand, in studies showing a very high prevalence of diabetes in early pancreatic cancer, subjects with resectable and small pancreatic cancers were screened for (asymptomatic) diabetes. Thus, from a screening perspective, the lesson to be learned from these studies is that one will to have screen asymptomatic subjects for new-onset diabetes and screening such subjects for cancer may detect resectable disease.…”

Section: Would Screening Subjects With New-onset Diabetes Detect Resementioning

confidence: 99%

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Detecting Early Pancreatic Cancer: Problems and Prospects

Chari

2007

Seminars in Oncology

153

133

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Pancreatic cancer has a poor prognosis. Improving survival will require diagnosis of early pancreatic cancer which can be defined based on resectability, size or curability. Pancreatic cancer progresses from non-invasive precursor lesions to invasive cancer over a variable time period. Retrospective review of CT scans done prior to diagnosis suggests that pancreatic cancer resectability may be significantly improved if detected as few as 6 months before clinical diagnosis. Since pancreatic cancer is relatively uncommon, to allow cost-effective screening the populations will have to be enriched for the disease using two "sieves", first would be a population of subjects at higher than average risk of pancreatic cancer and the second sieve could be a characteristic phenotype among the members of the high-risk group, an abnormality seen on non-invasive imaging or a serologic marker of early pancreatic cancer. So far two high risk groups have been targets of screening for pancreatic cancer, viz., hereditary pancreatic cancer kindreds and new-onset diabetes. There is no serologic marker of early pancreatic cancer. Confirmation of diagnosis usually requires invasive procedures such endoscopic ultrasonography. Though much work still needs to be done, the developments in the field provide us with hope that screening for early pancreatic cancer could become a reality in the not-so-distant future.

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Should pancreas imaging be recommanded in patients over 50 years when diabetes is discovered because of acute symptoms?

Cited by 51 publications

References 18 publications

Probability of Pancreatic Cancer Following Diabetes: A Population-Based Study

Probability of Pancreatic Cancer Following Diabetes: A Population-Based Study

Diabetes and pancreatic cancer

Detecting Early Pancreatic Cancer: Problems and Prospects

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