Risk factors and early signs of pancreatic cancer in diabetes: screening strategy based on diabetes onset age.
BACKGROUND
Diabetes mellitus (DM) has long been recognized as a risk factor for pancreatic cancer (PaC) and recently has attracted attention as a manifestation of PaC. Diabetes is expected to be a clue for the early detection of PaC; however, no effective screening strategy has been established.


METHODS
Forty diabetic patients with PaC were identified and compared with 120 diabetic patients without any malignancies. We analyzed risk factors for and early signs of PaC, focusing on the DM-onset age.


RESULTS
As there were peaks at 40-45 years and 60-65 years in the distribution of DM-onset age, we analyzed the clinical characteristics of and risk factors for PaC according to DM-onset age: i.e., early-onset (< 55 years) and late-onset (≥ 55 years). PaC was diagnosed within 2 years of DM onset (new-onset) in 0% of the patients with early-onset DM, and in 33% of those with late-onset DM. The mean duration of DM in patients with early-onset DM with PaC was longer than that in the late-onset patients (26 vs. 9 years; P < 0.01). A family history of DM (odds ratio [OR] 3.60) and use of insulin (OR 3.52) were significant risk factors in patients with early-onset DM, while the onset age of DM (OR 1.12) and multiple diabetic patients in the family (OR 6.13) were risk factors in those with late-onset DM. Body weight loss and exacerbation of DM were seen 12 months prior to PaC diagnosis in both groups.


CONCLUSIONS
Our study revealed specific risk factors for and similar early signs of PaC in early-onset and late-onset DM. Thus, we could develop a screening strategy, combining these risk factors specific for DM-onset age with early signs of disease.
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan.
Suguru
S
Mizuno
Yousuke
Y
Nakai
Hiroyuki
H
Isayama
Ayako
A
Yanai
Naminatsu
N
Takahara
Koji
K
Miyabayashi
Keisuke
K
Yamamoto
Kazumichi
K
Kawakubo
Dai
D
Mohri
Hirofumi
H
Kogure
Takashi
T
Sasaki
Natsuyo
N
Yamamoto
Naoki
N
Sasahira
Kenji
K
Hirano
Takeshi
T
Tsujino
Hideaki
H
Ijichi
Keisuke
K
Tateishi
Masao
M
Akanuma
Minoru
M
Tada
Kazuhiko
K
Koike
D017677:Age Distribution; D017668:Age of Onset; D000368:Aged; D015992:Body Mass Index; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology / Q000235:genetics; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology* / Q000235:genetics; D012307:Risk Factors; D013997:Time Factors
D007004:Hypoglycemic Agents; D007328:Insulin