ideasIdea
New diabetes after 50 plus weight loss triggers a pancreatic cancer check
About one in a hundred people who develop diabetes after 50, more if they are losing weight, have pancreatic cancer. A simple score could send them for a scan or blood test.
The ENDPAC score (Mayo Clinic) uses age, weight change, and glucose trajectory to enrich pancreatic cancer risk to roughly 3-4% in new-onset diabetes. Propose an automated EHR alert plus imaging or a CA19-9/methylation blood test for ENDPAC-high patients, evaluated in a pragmatic randomised trial.
Hypothesis
ENDPAC-triggered work-up raises the proportion of pancreatic cancers diagnosed at resectable stage among new-onset diabetics from about 15% to at least 35%.
Rationale
New diabetes is a paraneoplastic effect of early pancreatic cancer; the window is one to three years and the population is enumerable in primary care.
What would test it
Cluster-randomised trial across primary care networks; endpoints stage at diagnosis, resection rate, and scans per cancer.
Maturity
early clinical
Who has to act
clinic
Cost to try
Medium ($1M to $50M)
Years to first evidence
4
Bottlenecks it attacks
- Most lethal cancers are found late · Screening exists for only a few cancers. Pancreatic, ovarian, liver, oesophageal and most lung cancers are found when cure is unlikely.