Diabetes and Pancreatic Cancer: Both Cause and Effect

By now, it is known that diabetes mellitus is a risk factor for pancreatic cancer. The special section on pancreatic cancer in the American Cancer Society's Cancer Facts & Figures 2013 (1) states, "About 25% of patients with pancreatic cancer have diabetes mellitus at diagnosis, and roughly another 40% have pre-diabetes," that "patients with long-term (five or more years) type II diabetes have a 50% increased risk of pancreatic cancer" and "pancreatic cancer can cause diabetes, and sometimes diabetes is an early sign of the tumor." The direction of association goes both ways. Even though it takes about 10 to 15 years from pancreatic cancer initiation to diagnosis (2), most observable changes occur late in the disease course, though the trend in weight loss and cachexia is seen beginning perhaps 18 to 21 months before diagnosis (3), and we have shown that behaviors such as quitting cigarette smoking and starting proton pump inhibitor heartburn medication use and episodes of pancreatitis can be observed up to about two to three years before diagnosis as well (4).

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