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Adults who suddenly develop diabetes after 50 have several times the usual risk of pancreatic cancer. Test their blood.
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.
A scoring tool that needs no new test and can run in primary care records; it turns the 1 percent of Chari's cohort into a 3.6 percent group in whom imaging or a blood test becomes defensible.
The observation behind every new-onset diabetes strategy: a 1 percent prevalence is a hundred times the general population's and high enough for a blood test or scan to have a useful positive predictive value.
Shares Model to Determine Risk of Pancreatic Cancer in Patients With New-Onset Diabetes, Run the ENDPAC score on every new diabetes diagnosis after 50 and scan the high scorers, CA 19-9, Positive predictive value (PPV).
Shares Galleri, Positive predictive value (PPV), Multi-cancer early detection (MCED), The hardest cancers are found late.
Shares New-onset diabetes as a signal of pancreatic cancer (and the ENDPAC score), Intraductal papillary mucinous neoplasm and other pancreatic cystic precursors, The hardest cancers are found late, Pancreatic ductal adenocarcinoma.
Shares CA 19-9, High-risk pancreatic surveillance (CAPS / PRECEDE), Intraductal papillary mucinous neoplasm and other pancreatic cystic precursors, Multi-cancer early detection (MCED).
Shares Run the ENDPAC score on every new diabetes diagnosis after 50 and scan the high scorers, CA 19-9, Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question, Pancreatic ductal adenocarcinoma.
Shares Galleri, Positive predictive value (PPV), Multi-cancer early detection (MCED), Pancreatic ductal adenocarcinoma.
Shares Run the ENDPAC score on every new diabetes diagnosis after 50 and scan the high scorers, Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question, The hardest cancers are found late, Pancreatic ductal adenocarcinoma.
Shares Positive predictive value (PPV), Multi-cancer early detection (MCED), The hardest cancers are found late.