Recent-Onset Diabetes May Be a Sign of Pancreatic Cancer in African American, Latino Adults

While receiving a diagnosis of type 2 diabetes is common for US adults, African American and Latino adults over age 50 who receive a new diabetes diagnosis may have another health issue to be concerned about: pancreatic cancer.

Previous epidemiologic studies have shown a temporal association between diabetes and pancreatic cancer, and these studies have demonstrated that patients who have recent-onset diabetes have a higher risk of pancreatic cancer. However, this association has not been well examined in minority groups, who have the highest incidence of pancreatic cancer. A study newly published in the Journal of the National Cancer Institute, found that African American and Latino adults who had recent-onset diabetes had a significantly greater risk of pancreatic cancer than did patients who had long-term diabetes.

“There are very few studies on diabetes and pancreatic cancer that include Latinos and African-Americans,” says the study’s lead author, V. Wendy Setiawan, PhD, associate professor of preventive medicine at the Keck School of Medicine at the University of Southern California, in a statement. “Both groups have a high rate of diabetes, and African-Americans, in particular, have a higher risk of developing pancreatic cancer relative to other racial/ethnic groups.

The researchers drew their data from 20,403 African American and 28,592 Latino residents of California, aged 50 or over, who were part of the Multiethnic Cohort Study. From baseline (1993 to 1996) to 2013, 15,833 (32.3%) individuals total developed diabetes. Among this group, 128 participants also developed pancreatic cancer (age-adjusted incidence rate, 72.3 per 100,000). Among members of the cohort who did not develop incident diabetes, 280 developed pancreatic cancer (age-adjusted incidence rate, 36.0 per 100,000).

The frequency of incident diabetes was statistically significantly higher (P <.001) among participants who developed pancreatic cancer during follow-up than among those who developed 3 other cancer types: colorectal cancer, breast cancer, or prostate cancer. Similarly, the presence of recent-onset diabetes was “strikingly” higher (P <.001) among patients with pancreatic cancer (16.4%) versus colorectal (6.7%), breast (5.3%), or prostate (5.5%) cancer. In cases in which patients had both pancreatic cancer and diabetes, 52.3% of patients developed diabetes in the 36 months preceding their cancer diagnosis.

The association between recent onset diabetes and pancreatic cancer was statistically significant at all ages examined in the cohort, but the association declined with increasing age; at age 65, having recent-onset diabetes corresponded to an estimated hazard ratio (HR) of pancreatic cancer 6.56 (versus no diabetes). At ages 75 and 85, the HRs dropped to 3.71 and 2.26, respectively.

The authors of the study concluded that their results support a hypothesis that recent-onset diabetes in pancreatic cancer is itself a manifestation of developing pancreatic cancer. Patients with recent-onset diabetes who go on to develop pancreatic cancer should be studied for additional risk predictors that could help diagnoses patients earlier and improve survival.

“Because most people with pancreatic cancer are diagnosed at a late stage, the 5-year survival rate is low—about 8%,” said Setiawan. “Identifying people who are at high risk early on could potentially save their lives.”

Reference

Setiawan VW, Stram DO, Porcel J, et al. Pancreatic cancer following incident diabetes in African Americans and Latinos: the Multiethnic Cohort [published online June 18, 2018.] J Natl Cancer Inst. doi: 10.1093/jnci/djy090.