Pancreatic cancer is often called a “silent killer” – and for good reason. It lurks in the body, showing few or no symptoms until it has advanced to a dangerous, often untreatable stage. Despite advances in oncology, surgery, and chemotherapy, pancreatic cancer remains one of the deadliest cancers worldwide, with a dismal five-year survival rate of around 11%. But here’s the catch: if caught at stage 1, the five-year survival rate can shoot up to 44%. Unfortunately, only about 20% of pancreatic cancer cases are diagnosed this early. Why? Simply put, we lack reliable early-stage detection techniques.
Why Early Detection Matters
When you look at cancers like breast, colon, or cervical cancer, you’ll notice they all have something in common: screening protocols. Mammograms, colonoscopies, and Pap smears have saved countless lives by detecting cancer early, when treatment is most effective. Pancreatic cancer, on the other hand, has no routine screening tool.
By the time most patients develop noticeable symptoms – jaundice, weight loss, abdominal pain – the disease has already spread beyond the pancreas, limiting treatment options. Early detection is the single most important factor that could change the grim statistics we see today, but so far, medicine hasn’t cracked the code.
The Role of New-Onset Diabetes in Pancreatic Cancer Risk
One promising lead comes from an unexpected place: diabetes. Specifically, new-onset diabetes in individuals over 50 years old increases the risk of pancreatic cancer by six to eight times. But why does this happen? Researchers believe that as a pancreatic tumour grows, it interferes with insulin production and glucose metabolism, causing blood sugar levels to rise – sometimes years before other symptoms appear.
It’s not just newly diagnosed diabetes, though. For people who have had diabetes for more than two years, a sudden deterioration (measured as a >2% increase in HbA1c levels without obvious causes like weight gain or poor medication adherence) can be a red flag. This worsening may signal the early, hidden presence of pancreatic cancer – what researchers call “subclinical” cancer, meaning it’s there but not yet detectable by symptoms or routine tests.
The PANDOME Study
This ambitious clinical study, led by Frank et al. and published in The Journal of Clinical Endocrinology & Metabolism in 2025, enrolled 109 patients – 97 with new-onset diabetes and 12 with deteriorating diabetes. These patients underwent MRI scans and blood sample biobanking every six months for three years.
The results? Out of the entire group, one patient in the deteriorating diabetes group was found to have stage 1 pancreatic ductal adenocarcinoma (PDAC) – the most common type of pancreatic cancer. That’s a detection rate of just 0.9%. On the surface, this number seems discouraging. But let’s pause for a second. This is the first reported case of a screening-detected, early-stage pancreatic cancer in a group of people without a family history or known genetic risk – in other words, a sporadic cohort. That’s very important.
Why Aren’t We Screening Everyone With Diabetes?
Given this link, why don’t we just start routinely scanning everyone over 50 with new-onset or deteriorating diabetes? It’s not that simple.
First, the low detection rate raises questions about cost-effectiveness. MRI scans are expensive, time-consuming, and not without risk. Screening thousands of people to find a handful of cancers may not be practical or affordable – especially when healthcare systems are already stretched.
Second, not everyone with new-onset diabetes has pancreatic cancer. In fact, the vast majority don’t. Screening too broadly risks overwhelming the system and creating unnecessary anxiety, false positives, and possibly even harmful procedures for patients who don’t actually have cancer.
Third, we still lack clear biomarkers. While blood biobanking holds promise, researchers haven’t yet pinpointed reliable molecular or genetic signatures that can predict pancreatic cancer with confidence.
A Glimpse Into the Future: MRI-Based Diabetes-Specific Screening
Despite these hurdles, the PANDOME study offers a foundation for future research. The authors suggest that while current evidence doesn’t support routine imaging for all patients with new-onset or worsening diabetes, their results show clear promise.
Future studies could refine risk models – for example, combining age, weight loss patterns, family history, and changes in blood sugar markers to better identify high-risk individuals. Incorporating advanced MRI techniques, molecular imaging, or novel blood-based biomarkers could boost detection rates, making screening both more efficient and more affordable.
Imagine a future where a person over 50 with sudden diabetes changes goes in for a routine blood test, and doctors can tell – with reasonable accuracy – whether they need an MRI scan or follow-up. That’s the dream researchers are working toward, and it could revolutionise how we diagnose and treat pancreatic cancer.
A Race Against Time
The lack of early-stage detection techniques for pancreatic cancer is, in reality, the greatest obstacle in fighting this deadly disease. The lack of symptoms in its early stages means that most patients are diagnosed when it’s far too late for curative treatment. But thanks to studies like PANDOME and growing insights into the diabetes-cancer connection, we hope that we are inching closer to a solution.
Pancreatic Cancer Screening in New-onset and Deteriorating Diabetes: Preliminary Results From the PANDOME Study, Richard C Frank et al:
https://academic.oup.com/jcem/advance-article/doi/10.1210/clinem/dgaf319/8152681
