{"entity":{"id":"idea-mced-new-onset-diabetes","kind":"idea","name":"Blood-based pancreatic cancer detection in new-onset diabetes","aka":[],"tldr":"Adults who suddenly develop diabetes after 50 have several times the usual risk of pancreatic cancer. Test their blood.","summary":"Adults who develop diabetes after the age of 50 carry a raised risk of harbouring an occult pancreatic ductal adenocarcinoma, and this idea proposes testing their blood rather than waiting for symptoms. Risk-stratified testing with a multi-cancer early detection assay such as Galleri, or a multi-analyte CA 19-9 panel, would be offered to people with a high END-PAC score, with imaging reserved for those who test positive. Because cancer is far more prevalent in this enriched group, the positive predictive value of a blood test rises into a useful range. The test would be a prospective NOD-type cohort with blinded blood testing and three years of cancer ascertainment. At an early clinical stage, it addresses the bottleneck that the hardest cancers are found late.","asOf":"2026-09-06","links":[{"label":"PATHFINDER: the first prospective test of a multi-cancer blood test in people without symptoms (The Lancet 2023)","url":"https://doi.org/10.1016/S0140-6736(23)01700-2"},{"label":"NHS-Galleri: design of the largest randomised trial of a multi-cancer blood test (Cancers 2022)","url":"https://doi.org/10.3390/cancers14194818"}],"tags":[],"related":[],"cancers":["pancreatic"],"sections":[],"technologies":["mced","pancreatic-surveillance"],"targets":[],"drugs":["galleri"],"companies":[],"institutions":[],"pathways":[],"terms":["ppv","ca19-9"],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"Risk-stratified blood testing (MCED or multi-analyte CA19-9 panel) in high-END-PAC-score new-onset diabetes detects PDAC at resectable stage with acceptable PPV.","rationale":"Enriched prevalence (~1%) raises PPV to a useful range; imaging can be reserved for test-positives.","test":"Prospective cohort (NOD-type) with blinded blood testing and 3-year cancer ascertainment; compare stage distribution with contemporaneous controls.","maturity":"early-clinical"},"route":"/ideas/idea-mced-new-onset-diabetes/","neighbours":{"cancer":[{"id":"ipmn-cystic-precursors","kind":"cancer","name":"Intraductal papillary mucinous neoplasm and other pancreatic cystic precursors","route":"/cancers/ipmn-cystic-precursors/"},{"id":"pancreatic","kind":"cancer","name":"Pancreatic ductal adenocarcinoma","route":"/cancers/pancreatic/"}],"technology":[{"id":"pancreatic-surveillance","kind":"technology","name":"High-risk pancreatic surveillance (CAPS / PRECEDE)","route":"/technologies/pancreatic-surveillance/"},{"id":"mced","kind":"technology","name":"Multi-cancer early detection (MCED)","route":"/technologies/mced/"}],"drug":[{"id":"galleri","kind":"drug","name":"Galleri","route":"/drugs/galleri/"}],"term":[{"id":"ca19-9","kind":"term","name":"CA 19-9","route":"/terms/ca19-9/"},{"id":"new-onset-diabetes-pancreatic-cancer","kind":"term","name":"New-onset diabetes as a signal of pancreatic cancer (and the ENDPAC score)","route":"/terms/new-onset-diabetes-pancreatic-cancer/"},{"id":"ppv","kind":"term","name":"Positive predictive value (PPV)","route":"/terms/ppv/"}],"paper":[{"id":"paper-sharma-endpac-model-new-onset-diabetes-gastroenterology-2018","kind":"paper","name":"Model to Determine Risk of Pancreatic Cancer in Patients With New-Onset Diabetes","route":"/key-papers/paper-sharma-endpac-model-new-onset-diabetes-gastroenterology-2018/"},{"id":"paper-chari-pancreatic-cancer-following-diabetes-gastroenterology-2005","kind":"paper","name":"Probability of pancreatic cancer following diabetes: a population-based study","route":"/key-papers/paper-chari-pancreatic-cancer-following-diabetes-gastroenterology-2005/"}],"roadmap":[{"id":"pancreatic-roadmap","kind":"roadmap","name":"Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question","route":"/roadmaps/pancreatic-roadmap/"}],"idea":[{"id":"idea-pdac-new-onset-diabetes-risk-score-pathway","kind":"idea","name":"Run the ENDPAC score on every new diabetes diagnosis after 50 and scan the high scorers","route":"/ideas/idea-pdac-new-onset-diabetes-risk-score-pathway/"}],"bottleneck":[{"id":"b-early-detection","kind":"bottleneck","name":"The hardest cancers are found late","route":"/bottlenecks/b-early-detection/"}]}}