Three Things People with Diabetes Should Know about Pancreatic Cancer Risk

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Doctor pricks finger of patient with diabetes

MSK specialists advise people with diabetes that their risk of pancreatic cancer is low, but urge a healthy lifestyle to reduce complications from diabetes.

Pancreatic cancer and diabetes both involve the pancreas, which produces insulin. Your body needs insulin to use the sugar and fat from food. But what is the relationship between these two serious diseases? Should people with diabetes take their risk of pancreatic cancer into consideration when making complex decisions about their health and changes to their lifestyle?

The statistics are sobering: Pancreatic cancer accounts for just 3% of all cancers but is the fourth leading cause of cancer deaths in the United States. The disease often goes undiagnosed until it is advanced, when it is aggressive and hard to treat, and the number of new cases is on the rise, despite a fall in some major risk factors, like smoking.

The most important take-home lesson is for people to control their weight, says Azeez Farooki. That can lower your chances of developing diabetes and it may lower your risk of developing diabetes-related cancer.

By comparison, diabetes is distressingly common. Nearly 30 million people in America have diabetes. An estimated seven million of them are not aware they have it.

It’s long been known that diabetes is a risk factor for various cancers, including pancreatic cancer. Recent research suggests that the risk for people with diabetes may be even higher — although only slightly — when the disease comes on after age 50.

To find out more about what people with diabetes should know about pancreatic cancer, we spoke with MSK endocrinologists Azeez Farooki and James Flory

1. Diabetes does not significantly raise your risk of pancreatic cancer.

Dr. Flory advises people with diabetes to stay calm. He points out that more than a million people a year develop diabetes, while just 55,000 people are diagnosed with pancreatic cancer each year. “People over 50 who are diagnosed with diabetes should not start thinking about being screened for pancreatic cancer or spend a lot of time worrying about it,” he says. “The overwhelming majority of people with diabetes will never develop pancreatic cancer.” 

While research shows that there is a relationship between the two diseases, Dr. Flory says, “It’s not yet clear which disease causes the other or if they share a similar underlying cause. The bottom line for people with diabetes is that their increased risk of pancreatic cancer is very small.”

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2. A sudden change in diabetes could signal a problem. 

There are some situations, though, in which it pays to be extra vigilant.

Endocrinologists Azeez Farooki and James Flory

Endocrinologists Azeez Farooki and James Flory

“If someone is lean, exercises, and develops diabetes out of nowhere, or if they have a history of well-controlled diabetes and suddenly it gets a lot worse, that should make a doctor wonder if there is an underlying problem, which could include pancreatic cancer,” says Dr. Farooki. “Your doctor should consider this in relation with other risk factors. These include a family history of pancreatic and other cancers, smoking, and damage to the pancreas from behaviors like heavy drinking. Also important to consider is that pancreatic cancer often causes unexplained and unintentional weight loss.”   

He cautions that “diabetes can worsen over time and require more medications to control it, so the vast majority of the time it’s simply a bad turn in diabetes.” However, it’s always important to be in touch with your care team if your condition changes dramatically.   

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3. Manage your weight, no matter what.

Both doctors say that the key for people who are concerned about these two diseases is diet and exercise. Dr. Farooki says, “The most important take-home lesson is for people to control their weight. That can lower your chances of developing diabetes. And if you already have the disease, it can mean fewer complications and may lower your risk of developing diabetes-related cancers, including pancreatic and endometrial cancer.” 

It’s important for people to be aware of their ideal body weight and understand that obesity, prediabetes, and diabetes are all cancer risk factors, says Dr. Farooki. “One thing we see over and over again with many patients is that they don’t recognize they are overweight and their doctor has never told them they need to lose weight,” he explains. “It’s become so normal in today’s world to be seriously overweight, and it has real consequences.”

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Comments

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My husband had diabete. His diet & life style did not contribute to it. Four years ago he was diagnosed with bile duct cancer, was treated at MSKCC. He was already in Stage IV. Since his death almost 3 years ago I have learned that this is extremely common in other Vietnam Veterans who have had diabetes and who were exposed to Agent Orange. In some cases the VA grants service connection to Veterans and/or their widows. In other cases they don’t. All I needed was my husband’s physician st MSKCC to state that his AO exposure “may or may not”!have caused his Cholangiocarcinoma!

Dear Patricia, we are very sorry for your loss. Best wishes to you.

As doctors, shouldn't you know that your body is going to weigh what it wants to weigh, and humans have very little control over our "weight." You should take out the fatphobic, stigmatizing language in this article and replace it with behaviors that may increase pancreatic health.

Dear Cocoa, there are a number of studies that have linked obesity to an increased risk of cancer. You can learn more about this topic here and here. Thank you for your comment.

Many of my relatives have died of pancreatic cancer. Most were diagnosed rather late in the disease course because, at least in one case, the doctor did not order a serum bilirubin until late in the game. Is that test a screening measure for diabetics?

Dear Karen, we’re sorry to hear that you’ve lost so many family members to cancer. The standard tests to diagnose diabetes, according to the National Institute of Diabetes and Digestive and Kidney Diseases, are the fasting plasma glucose (FPG) test, the A1C test, and the random plasma glucose (RPG) test. The serum bilirubin test looks for liver problems and blockages of the bile ducts.

If you think your family might carry a gene for hereditary cancer, you may be interested in joining our Pancreatic Tumor Registry.

Thank you for your comment and best wishes to you.