Recently diagnosed diabetics over the age of 50 years, in particular those who are not overweight have 4 to 7 times the risk of pancreatic cancer in contrast to general population.
In the UAE, the International Diabetes Federation (IDF) stated that 17.3 percent of the adult population of the United Arab Emirates (UAE), more than 1 million people, had type 2 diabetes mellitus (DM), positioning the country 15th globally for age adjusted prevalence. They stated that the prevalence of DM is increasing rapidly in the UAE than any other part of the world and would likely double by the year 2040 due to the sedentary lifestyle and increasing prevalence of obesity in the region.
Pancreatic cancer is the 10th most common cancer in the UAE but the 5th most common cause of death from cancer. It includes about 1% of all cancers in the region. However, the prevalence of this cancer among females in UAE is the highest in the world at 10.1 cases per 100,000 population. Even with the best available treatment the five-year survival rate in patients with pancreatic cancer continues to be below five percent and has not appreciably enhanced over the past three decades.
“The relation between Type 2 DM and pancreatic cancer is complex. Although factors such as obesity, insulin resistance and sedentary lifestyle are common risk elements for both diseases, long-standing Type 2 DM independently raises the risk for pancreatic cancer by 1.5 to 2 times over the general population,” stated Dr Sanjay Govil of Apollo Hospitals.
The prevalence of DM in patients with pancreatic cancer starts to rise 2 to 3 years before the cancer diagnosis and is greatest in patients newly diagnosed with DM within the last 1 year. It is 4 to 7 times more common among patients with established pancreatic cancer than that reported in the general population. More than half the patients with a concurrent diagnosis of DM and Pancreatic cancer are recently diagnosed diabetics. They differ from the ‘normal’ diabetic patient in that they are normally over 50 years of age, are either not overweight or have lost weight in the 6 months before diagnosis of DM. Diabetes in these currently diagnosed patients frequently resolves after pancreatic resection, suggesting that it is caused by a substance produced by the cancer itself. One of the diabetogenic substances produced by these cancers is Islet Amyloid Polyppeptide (IAPP).
Since the diagnosis of DM precedes the diagnosis of pancreatic cancer, scientists are making an attempt to find affordable ways to screen newly diagnosed diabetics for this cancer before the onset of symptoms. Sophisticated CT or MRI scans are unable to identify pancreatic cancers until around 6 months prior to onset of symptoms because they are too small to be found out by these modalities. Making an early diagnosis may require invasive procedures like endoscopic ultrasound. Such tests cannot be advised for huge segments of the population, so scientists are trying to further whittle down newly diagnosed diabetics at risk for pancreatic cancer by identifying a tumour marker in the blood. The recently available tumour markers such as CA 19/9 are not useful in this regard. The search for a clinically useful marker is ongoing.
Until such a tumour marker is identified, the best way to prevent DM and Pancreatic cancer is to eat sensibly, stay active, exercise regularly and avoid smoking.