medwireNews: Type 2 diabetes and weight loss are independently associated with an increased risk for pancreatic cancer, and this risk is further elevated when weight loss occurs together with recent-onset diabetes, according to results from a cohort study.
Chen Yuan, from the Dana-Farber Cancer Institute in Boston, Massachusetts, USA, and fellow researchers analyzed data from 112,818 women, with a mean age of 59.4 years, and 46,207 men, with a mean age of 64.7 years, obtained from the Nurses’ Health Study (NHS) and the Health Professionals Follow-Up Study (HPFS), respectively.
The team identified a total of 1116 incident cases of pancreatic cancer, giving an incidence rate of 25 per 100,000 person–years during 4.5 million person–years of follow-up.
In all, 937 individuals with known diabetes status developed pancreatic cancer; 14.4% of these people had long-standing (>4 years) diabetes, while 7.2% had recent-onset (≤4 years) diabetes. Yuan and colleagues report that individuals with diabetes had a significantly higher risk for pancreatic cancer than those without diabetes, with age-adjusted hazard ratios (HRs) of 2.97 for those with recent-onset diabetes and 2.16 for those with long-standing diabetes. They add that “these elevated cancer risks were present for individuals regardless of their BMI.”
There was also a significant association between recent weight loss and pancreatic cancer risk, with age-adjusted HRs of 1.25, 1.33, and 1.92 for the groups who had lost 1–4 lb (0.45–1.81 kg), 5–8-lb (2.27–3.63 kg), and more than 8 lb (3.63 kg), respectively, over the previous 2 years when compared with individuals in the no weight loss group.
Therefore, “diabetes and recent weight loss were each independently associated with a moderate increase in the risk for pancreatic cancer,” write Yuan et al in JAMA Oncology.
However, when these variables were analyzed together, individuals with recent-onset diabetes combined with weight loss of 1–8 lb or more than 8 lb had a “substantially” higher incidence of pancreatic cancer, with age-adjusted HRs of 3.61 and 6.75, respectively, compared with individuals with neither exposure.
On the other hand, for people with long-standing diabetes and weight loss, the team says that the increased risk for pancreatic cancer was “less pronounced,” with HRs of 2.90 for individuals with a loss of 1–8 lb, and 2.80 for the group with a loss of more than 8 lb. These results were consistent when the NHS and HPFS cohorts were analyzed separately.
The researchers also carried out stratified analyses “[t]o further define groups with a high risk for pancreatic cancer” among individuals with recent-onset diabetes and weight loss, finding that people aged 70 years or older, those with a BMI of less than 25 kg/m2 before weight loss, and those with a low likelihood of intentional weight loss as indicated by changes in physical activity and diet had “particularly high” incidence rates of pancreatic cancer.
The team concludes that “recent-onset diabetes accompanied by weight loss [...] may represent a high-risk group in the general population for whom early detection strategies would be advantageous.”
JAMA Oncol 2020; doi:10.1001/jamaoncol.2020.2948
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