# Blood-based pancreatic cancer detection in new-onset diabetes

Source: https://onco.cc/ideas/idea-mced-new-onset-diabetes/  
OnCo record `idea-mced-new-onset-diabetes` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

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.

## Fields

- Kind: Idea
- Last checked: 2026-09-06
- 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.
- Proposed test: Prospective cohort (NOD-type) with blinded blood testing and 3-year cancer ascertainment; compare stage distribution with contemporaneous controls.
- Maturity: early-clinical

## Sources

- PATHFINDER: the first prospective test of a multi-cancer blood test in people without symptoms (The Lancet 2023): https://doi.org/10.1016/S0140-6736(23)01700-2
- NHS-Galleri: design of the largest randomised trial of a multi-cancer blood test (Cancers 2022): https://doi.org/10.3390/cancers14194818

## Connected records

- cancers: [Intraductal papillary mucinous neoplasm and other pancreatic cystic precursors](https://onco.cc/cancers/ipmn-cystic-precursors/), [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/)
- technologies: [High-risk pancreatic surveillance (CAPS / PRECEDE)](https://onco.cc/technologies/pancreatic-surveillance/), [Multi-cancer early detection (MCED)](https://onco.cc/technologies/mced/)
- drugs: [Galleri](https://onco.cc/drugs/galleri/)
- terms: [CA 19-9](https://onco.cc/terms/ca19-9/), [New-onset diabetes as a signal of pancreatic cancer (and the ENDPAC score)](https://onco.cc/terms/new-onset-diabetes-pancreatic-cancer/), [Positive predictive value (PPV)](https://onco.cc/terms/ppv/)
- key papers: [Model to Determine Risk of Pancreatic Cancer in Patients With New-Onset Diabetes](https://onco.cc/key-papers/paper-sharma-endpac-model-new-onset-diabetes-gastroenterology-2018/), [Probability of pancreatic cancer following diabetes: a population-based study](https://onco.cc/key-papers/paper-chari-pancreatic-cancer-following-diabetes-gastroenterology-2005/)
- roadmaps: [Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question](https://onco.cc/roadmaps/pancreatic-roadmap/)
- ideas: [Run the ENDPAC score on every new diabetes diagnosis after 50 and scan the high scorers](https://onco.cc/ideas/idea-pdac-new-onset-diabetes-risk-score-pathway/)
- bottlenecks: [The hardest cancers are found late](https://onco.cc/bottlenecks/b-early-detection/)

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