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The 2018 Mayo Clinic score, called ENDPAC, that uses weight change, blood sugar change and age at diabetes onset to pick out the new diabetics whose risk of pancreatic cancer is high enough to scan.
Sharma, Chari and colleagues built the Enriching New-Onset Diabetes for Pancreatic Cancer (ENDPAC) model from four cohorts (1,561 patients) with glycaemically defined new-onset diabetes in the Rochester Epidemiology Project, 2000 to 2015, weighting three factors, change in weight, change in blood glucose and age at onset, and validated it in an independent cohort of 1,096. In the discovery cohort (64 pancreatic cancer, 192 type 2 diabetes) the area under the curve was 0.87 and a score of 3 or more had 80 percent sensitivity and specificity; in validation a score of 3 or more identified 7 of 9 cancers (78 percent) at 85 percent specificity, with a cancer prevalence of 3.6 percent among high scorers, 4.4-fold that of new-onset diabetes overall. A score of 0 or below (49 percent of patients) meant extremely low risk. A high score identified 75 percent of cases more than six months before diagnosis.
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.
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.
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.
Shares Lead-Time Trajectory of CA19-9 as an Anchor Marker for Pancreatic Cancer Early Detection, Run the ENDPAC score on every new diabetes diagnosis after 50 and scan the high scorers, 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 Run the ENDPAC score on every new diabetes diagnosis after 50 and scan the high scorers, CT (computed tomography), 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 CT (computed tomography), 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 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, Pancreatic ductal adenocarcinoma and the tag pancreatic-evidence.
Shares 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, Pancreatic ductal adenocarcinoma and the tag pancreatic-evidence.
Shares 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, Pancreatic ductal adenocarcinoma and the tag pancreatic-evidence.
Shares Mayo Clinic, 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.