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New-onset diabetes: a link to help detect cancer earlier

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by Cancer Research UK | Research Feature

14 February 2019

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Professor Eithne Costello, a molecular biologist based at the University of Liverpool, is developing a diagnostic test to detect pancreatic cancer at an early stage in individuals with new-onset diabetes. With the support of our Early Detection Programme Award, the help of a team of experts and a UK-wide clinical network, she will be linking up her work with a US cohort study on the relationship between new-onset diabetes and pancreatic cancer and how this could be used to help diagnose the disease earlier.

Tackling pancreatic cancer early on

‘For most pancreatic cancer patients, pancreatic cancer is detected after the disease has spread, which limits their treatment options. In a small percentage of people, where there is a strong family history, they may be screened for early signs of the disease. But for most people, there’s no screening and we don’t have a specific marker of early pancreatic cancer.

‘Around half of pancreatic cancer patients experience new-onset diabetes and there’s evidence to suggest that the diagnosis of diabetes precedes the pancreatic cancer diagnosis by about 12 months, so there’s a potential window there during which an early intervention could be made.

‘What we would like to do is to see if we can diagnose the cancer at the same time as the diabetes is diagnosed. Our research proposes to collect the first UK cohort aimed specifically at registering individuals and collecting their samples and data in order to identify pancreatic cancer patients. We will validate existing biomarkers and look for new ones that will allow us to stratify for risk of pancreatic cancer in individuals with new-onset diabetes mellitus.’

An international effort 

In the US, the Consortium of Chronic Pancreatitis, Diabetes and Pancreatic Cancer has launched their own large cohort study, led by Professor Suresh Chari.

‘We decided to exploit the relationship between new-onset diabetes and pancreatic cancer to detect the disease, after much discussion with European colleagues within EUPancreas – a research network led by Nuria Malats from the Spanish National Cancer Research Center.

‘We are now working closely with Professor Stephen Pandol, one of the leaders of the US consortium, and other members of that consortium, including Professor Chari. Our ongoing collaborative relationship will allow us to share data and samples.  

‘This will be vital to ensure that what we are doing in the UK can link seamlessly with the US study and lead to more substantial results.’

Developing a test to find out who is most at risk

‘There are more than 200,000 cases of new-onset diabetes every year in the UK and only 1% of these goes on to receive a diagnosis of pancreatic cancer.

‘We aim to develop a diagnostic test for use in individuals newly diagnosed with diabetes which can identify those most at risk of having asymptomatic pancreatic cancer, allowing them to be monitored for signs of the disease.

‘A biomarker that can distinguish Type3C diabetes, where the condition is secondary to pancreatic disease, from the more common Type 2 diabetes would enable us to select our subgroup.

‘We’ll be working closely both with the Liverpool Clinical Trials Centre, and the Experimental Cancer Medicine Centre (ECMC) here in Liverpool, which will be instrumental in ensuring that we recruit patients and are also providing infrastructure to our study.’

We will be getting samples from individuals before the diagnosis of pancreatic cancer has been made. Pre-diagnostic samples have never been collected for the specific purpose of detecting pancreatic cancer before – it’s a rare and fantastic opportunity to do some novel work in this area.

Raising awareness amongst people with diabetes and health professional

‘We’re also committed to creating awareness about the link between new-onset diabetes and pancreatic cancer, both within the clinical and medical professions and amongst people with diabetes. But we have to do it carefully, and make sure the public is aware that the chances of a diagnosis of pancreatic cancer are small, even among people with diabetes. 

‘Pancreatic cancer is the most lethal common cancer, with five-year survival being as low as 5-7%. Currently we’re not able to offer surgery to 4 in 5 pancreatic cancer patients, because at the time they are diagnosed, their cancer is too advanced. If we can detect the disease earlier, so that surgery is an option, the five-year survival rate would go up enormously.’

Raising awareness around the link between new-onset diabetes and pancreatic cancer would have vast implications for people affected by it.

Advice for future applicants: ask any questions to CRUK and allow plenty of time

‘I’d advise applicants to work closely with the people in charge of the call – and to start early. The process is much more involved than you can possibly imagine! Start thinking about your project very early, at least a year before the deadline.

‘I took advantage of the opportunity to call and email the funding managers about the Early Detection Programme Award – it was the first time that I’ve been so proactive on liaising with the funder because I just wanted to get it right. I wanted to understand very clearly what Cancer Research UK wanted.’