Cited by 150Pancreatic and Hepatic Oncology ResearchCancer Risks and FactorsMetabolism, Diabetes, and Cancer

Diabetes, weight change, and pancreatic cancer risk

Open access
Yuan, Chen, Babic, Ana, Khalaf, Natalia, Nowak, Jonathan A., Brais, Lauren K., Rubinson, Douglas A., Ng, Kimmie, Aguirre, Andrew J. +8 more·2020·JAMA Oncology

Abstract

Importance: Pancreatic cancer is the third-leading cause of cancer death in the United States; however, few high-risk groups have been identified to facilitate early diagnosis strategies. Objective: To evaluate the association of diabetes duration and recent weight change with subsequent risk of pancreatic cancer in the general population. Design, Setting, and Participants: This cohort study obtained data from female participants in the Nurses' Health Study and male participants in the Health Professionals Follow-Up Study, with repeated exposure assessments over 30 years. Incident cases of pancreatic cancer were identified from self-report or during follow-up of participant deaths. Deaths were ascertained through reports from the next of kin, the US Postal Service, or the National Death Index. Data collection was conducted from October 1, 2018, to December 31, 2018. Data analysis was performed from January 1, 2019, to June 30, 2019. Exposures: Duration of physician-diagnosed diabetes and recent weight change. Main Outcome and Measures: Hazard ratios (HRs) for subsequent development of pancreatic cancer. Results: Of the 112 818 women (with a mean [SD] age of 59.4 [11.7] years) and 46 207 men (with a mean [SD] age of 64.7 [10.8] years) included in the analysis, 1116 incident cases of pancreatic cancers were identified. Compared with participants with no diabetes, those with recent-onset diabetes had an age-adjusted HR for pancreatic cancer of 2.97 (95% CI, 2.31-3.82) and those with long-standing diabetes had an age-adjusted HR of 2.16 (95% CI, 1.78-2.60). Compared with those with no weight loss, participants who reported a 1- to 4-lb weight loss had an age-adjusted HR for pancreatic cancer of 1.25 (95% CI, 1.03-1.52), those with a 5- to 8-lb weight loss had an age-adjusted HR of 1.33 (95% CI, 1.06-1.66), and those with more than an 8-lb weight loss had an age-adjusted HR of 1.92 (95% CI, 1.58-2.32). Participants with recent-onset diabetes accompanied by weight loss of 1 to 8 lb (91 incident cases per 100 000 person-years [95% CI, 55-151]; HR, 3.61 [95% CI, 2.14-6.10]) or more than 8 lb (164 incident cases per 100 000 person-years [95% CI, 114-238]; HR, 6.75 [95% CI, 4.55-10.00]) had a substantially increased risk for pancreatic cancer compared with those with neither exposure (16 incident cases per 100 000 person-years; 95% CI, 14-17). Incidence rates were even higher among participants with recent-onset diabetes and weight loss with a body mass index of less than 25 before weight loss (400 incident cases per 100 000 person-years) or whose weight loss was not intentional judging from increased physical activity or healthier dietary choices (334 incident cases per 100 000 person-years). Conclusions and Relevance: This study demonstrates that recent-onset diabetes accompanied by weight loss is associated with a substantially increased risk for developing pancreatic cancer. Older age, previous healthy weight, and no intentional weight loss further elevate this risk.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1001/jamaoncol.2020.2948

Cites

41 of 41 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • People who have new-onset diabetes plus an END-PAC score of 3 or more form a group whose PDAC risk is high enough that screening might help.

    “One such cohort is subjects with new-onset diabetes and a high score (≥3) on the Enriching New-Onset Diabetes for Pancreatic Cancer (END-PAC) model.4”

    From Radiomics-based Machine-learning Models Can Detect Pancreatic Cancer on Prediagnostic Computed Tomography Scans at a Substantial Lead Time Before Clinical Diagnosis (2022) · cites this paper as [4]

    The Discussion (page unavailable) identifies recent-onset diabetes accompanied by weight loss as a higher-risk group and says whether that group should undergo pancreatic cancer surveillance warrants prospective study. The paper does not identify an END-PAC score of ≥3 as the criterion for that group or assess screening for people meeting that cutoff. (LLM, conf=0.86)

    Experimental — accuracy not yet measured
  • Detecting PDAC earlier improves survival beyond the effect of lead time, since smaller tumors are more often resectable.

    “Early detection offers survival benefit beyond lead time, as tumors are smaller in volume and more likely to be resectable when detected earlier.2-4”

    From Radiomics-based Machine-learning Models Can Detect Pancreatic Cancer on Prediagnostic Computed Tomography Scans at a Substantial Lead Time Before Clinical Diagnosis (2022) · cites this paper as [4]

    The Introduction reports earlier-stage diagnosis and longer survival among patients undergoing surveillance, and the Discussion says early-stage pancreatic cancer can be cured with aggressive treatment. The paper also describes a window in which some tumors are surgically resectable. It does not establish that the survival benefit exceeds lead-time effects or attribute greater resectability to smaller tumor volume. Page numbers are unavailable in our copy. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Authors
Yuan, C., Babic, A., Khalaf, N., Nowak, J. A., Brais, L. K., Rubinson, D. A., Ng, K., Aguirre, A. J., Pandharipande, P. V., Fuchs, C. S., Giovannucci, E. L., Stampfer, M. J., Rosenthal, M. H., Sander, C., Kraft, P., & Wolpin, B. M.
Affiliations
  • Harvard University (US)
  • Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
  • Michael E. DeBakey VA Medical Center (US)
  • Brigham and Women's Hospital (US)
  • Yale Cancer Center (US)
Corresponding author
Yuan, Chen
Venue
JAMA Oncology
Published
2020-10-08
Volume
6
Issue
10
Pages
e202948
ISSN
2374-2437 (ISSN-L)
OpenAlex
W3048739465
Cited by
150
References
40
Citations by year
2026: 28 · 2025: 31 · 2024: 17 · 2023: 24 · 2022: 28 · 2021: 22
FWCI
6.68
Type
journal article
Language
en
Open access
Locations
  • JAMA Oncology (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Cancer Institute (K08CA218420, R01CA205406)
Topics
  • Health Sciences › Medicine › Oncology › Pancreatic and Hepatic Oncology Research
  • Health Sciences › Medicine › Oncology › Cancer Risks and Factors
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Metabolism, Diabetes, and Cancer
Keywords
pancreatic cancer risk, diabetes duration, weight loss, recent-onset diabetes, long-standing diabetes, diabetes and cancer association, cancer risk factors, prospective cohort, Nurses' Health Study, Health Professionals Follow-up Study, early cancer detection, obesity and cancer risk, cancer screening guidelines, cancer survivorship, cancer survivorship support services, survivorship care
MeSH terms
Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Pancreatic Neoplasms, Cohort Studies, Weight Loss, Body Mass Index, Incidence, Diabetes Complications

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review