Z Gastroenterol 2014; 52 - A25
DOI: 10.1055/s-0034-1376085

Benefits of screening for pancreatic cancer in new-onset diabetes mellitus

D Illés 1, G Zsóri 1, V Terzin 1, T Wittmann 1, L Czakó 1
  • 1First Department of Medicine, University of Szeged, Szeged, Hungary

Background: The incidence-mortality ratio of pancreatic cancer is close to 1. Screening of the average population is not cost-effective because the lifetime prevalence of pancreatic cancer is only 1.39%. Diabetes mellitus seems to be an independent risk factor for pancreas cancer.

Objective: To assess the role of noninvasive diagnostic means (serum CA 19 – 9 level, transabdominal ultrasonography/US/and computer tomography/CT/) in screening for pancreas cancer among patients with new-onset diagnosed (within 36 months) diabetes mellitus.

Methods: Patients with new-onset type-2 diabetes mellitus were enrolled in a prospective study. Symptoms suggestive of pancreatic disease were excluding factors. The serum CA 19 – 9 level was measured 6-monthly, and US was performed yearly. If the CA 19 – 9 level was elevated or US showed any abnormality, CT was performed. Endoscopic ultrasound-guided fine needle aspiration or direct surgical referral was performed on patients with CT-identified lesions.

Results: A total of 73 patients (34 men, 39 women, mean age: 59.01 ± 11.09 years) were enrolled. The serum CA 19 – 9 level was elevated in 8 patients (10.95%), but no abnormality was revealed by US or CT. Imaging examinations detected pancreas cancer in 2 patients (2.74%), but the CA 19 – 9 was not elevated. The sensitivity, specificity, and positive and negative predictive values of CA 19 – 9, US and CT were 0%, 88.7%, 0% and 96.9%; 50%, 100%, 100% and 98.6%; and 100%, 100%, 100%, and 100%, respectively. The value of the Standardized Incidence Ratio was 324.82 (95% CI = 9.11 – 15.46).

Conclusions: The likelihood of pancreatic cancer in patients with new-onset type-2 diabetes is significantly higher than that in the general population, and screening of this population for pancreatic cancer can therefore be recommended. US, together with CT in uncertain cases, can be a reliable screening modality, whereas CA 19 – 9 is not effective for pancreas cancer screening.