Risk of Pancreatic Cancer in Glycemically Defined New-Onset Diabetes: A Prospective Cohort Study

BACKGROUND & AIMS: The increased 3-year incidence of pancreatic cancer after new-onset diabetes observed in retrospective studies needs prospective validation. It is unknown whether incidence varies by race and ethnicity. METHODS: In a prospective, observational study using active real-time surveillance of electronic health records, we identified 18,838 adults 50 years or older with glycemically defined new-onset diabetes (GNOD). In this interim analysis, we report 3-year Kaplan-Meier estimates of the proportion diagnosed with pancreatic cancer after GNOD (absolute incidence [95% CI]) and associated standardized incidence ratio (SIR) by race and ethnicity, overall 3-year incidence of pancreatic cancer adjusting for racial distribution of incident diabetes in the United States, and interval between GNOD and pancreatic cancer diagnosis. RESULTS: During median follow-up of 2.3 years, 82 pancreatic cancers were diagnosed (60% in men; mean [SD] age, 71 [8] years). The 3-year estimates for the proportion diagnosed with pancreatic cancer and associated SIR by race and ethnicity were as follows: non-Hispanic White patients (n = 6518): 0.84% (95% CI, 0.60%-1.07%) and 6.4 (95% CI, 4.8-8.4); Hispanic patients (n = 5984): 0.40% (95% CI, 0.20%-0.60%) and 4.2 (95% CI, 2.6-6.3); African American patients (n = 2192): 0.37% (95% CI, 0.07%-0.67%) and 2.4 (95% CI, 1.0-5.0), and Asian/Pacific Islander patients (n = 3360): 0.22% (95% CI, 0.06%-0.39%) and 3.0 (95% CI, 1.4-6.0). Overall, race-adjusted 3-year pancreatic cancer incidence was 0.62%. On average, GNOD occurred 8 months before clinical diagnosis (0-4 months in 30.5%, 4-12 months in 31.3%, 12-24 months in 19.5%, and 24-36 months in 18.7%). CONCLUSIONS: GNOD, identifiable in real time using active surveillance of electronic health records, is associated with a high 3-year incidence of pancreatic cancer with marked racial and ethnic differences. Longer-term risk needs further study.