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Blood-based pancreatic cancer detection in new-onset diabetes

Adults who suddenly develop diabetes after 50 have several times the usual risk of pancreatic cancer. Test their blood.

About 1% of new-onset diabetes after age 50 is caused by an occult pancreatic cancer (~6-8x relative risk in the first 3 years). The END-PAC risk model and the NCI New Onset Diabetes (NOD) cohort define a testable population; MCED, CA19-9 variants, and AI-read CT are candidate tests.

Confidence
25%50%likelyOnCo editors (initial estimate), 2026-09-07 · Enrichment strategy is sound; stage-shift evidence needed.
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.
What would test it
Prospective cohort (NOD-type) with blinded blood testing and 3-year cancer ascertainment; compare stage distribution with contemporaneous controls.
Maturity
early clinical

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