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About 1 in 100 people who develop diabetes after 50 has a pancreatic cancer behind it. A score built from weight change, blood sugar change and age, calculable from records already in primary care, picks out a group where the rate is nearer 1 in 30; the proposal is to scan that group rather than wait for symptoms.
Chari's population cohort found pancreatic cancer in 0.85 percent of 2,122 new diabetics aged 50 or over within three years, an observed-to-expected ratio of 7.94, with 10 of 18 diagnosed within six months of the diabetes. Sharma's ENDPAC model (weight change, glucose change, age at onset) had an area under the curve of 0.87; in validation a score of 3 or more identified 78 percent of cancers at 85 percent specificity, with a prevalence of 3.6 percent among high scorers, and a score of 0 or below in 49 percent of patients marked extremely low risk. The proposal is a pragmatic pathway, not a new test: an automated ENDPAC flag in the primary care record at diabetes diagnosis, contrast CT or MRI for scores of 3 or more, and CA 19-9 with awareness that Lewis-negative patients (Tempero 1987) cannot make it. It is distinct from the existing OnCo idea of a blood-based multi-cancer test in the same population and can precede it, because imaging is available now. The test is a prospective cohort with stage at diagnosis against contemporaneous controls; the Hungarian NODES cohort (2,522 estimated) and the US NOD cohort are the nearest running studies. The UK, where diabetes diagnoses are coded in a single primary care system, is an unusually good place to run it.
Fixes the window in which a blood test could plausibly work and shows why CA 19-9 alone is not enough: half of early cases are missed even at diagnosis, and Lewis-negative patients are missed entirely.
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.
The reason a normal CA 19-9 never rules pancreatic cancer out, why Lewis-negative patients need a different marker (CA 125, CEA or CA 19-9-independent panels), and a constraint on every blood-based detection idea on this page.
Shares High-risk pancreatic surveillance (CAPS / PRECEDE), CT (computed tomography), MRI, The hardest cancers are found late and the tag pancreatic-evidence.
Shares Early detection roadmap: organ screening → blood tests for many cancers, High-risk pancreatic surveillance (CAPS / PRECEDE), MRI, The hardest cancers are found late and the tag pancreatic-evidence.
Shares High-risk pancreatic surveillance (CAPS / PRECEDE), MRI, The hardest cancers are found late, Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question and the tag pancreatic-evidence.
Shares A fast-track pathway from suspicion to treatment for pancreatic cancer in the NHS, measured from first scan to first treatment, Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question, Pancreatic ductal adenocarcinoma and the tag pancreatic-evidence.
Shares High-risk pancreatic surveillance (CAPS / PRECEDE), MRI, The hardest cancers are found late, Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question and the tag pancreatic-evidence.
Shares High-risk pancreatic surveillance (CAPS / PRECEDE), Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question, Pancreatic ductal adenocarcinoma and the tag pancreatic-evidence.
Shares Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question, Pancreatic ductal adenocarcinoma and the tag pancreatic-evidence.
Shares Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question, Pancreatic ductal adenocarcinoma and the tag pancreatic-evidence.