MRI Screening Shows Promise for Early Pancreatic Cancer Detection in Diabetes Patients

The potential of MRI-based screening to detect early-stage pancreatic cancer in older adults suffering from new-onset or deteriorating diabetes has gained attention following preliminary findings from the PANDOME study. Conducted by Dr. Richard Frank, MD, of the Division of Hematology/Oncology at Nuvance Health in Norwalk, Connecticut, the study highlights the urgent need for targeted screening methods in this high-risk population.

According to the study, which was published in the Journal of Clinical Endocrinology & Metabolism on July 3, 2025, patients over the age of 50 with newly diagnosed diabetes are at a significantly higher risk for developing pancreatic cancer—six to eight times greater than individuals without diabetes. Furthermore, the deterioration of long-standing diabetes, indicated by a notable increase in A1c levels, also serves as a potential warning sign for subclinical pancreatic cancer.

Among the 109 participants in the PANDOME study, those with new-onset diabetes (n = 97, median age 61 years) and those experiencing deteriorating diabetes (n = 12, median age 68 years) underwent MRI and cholangiopancreatography. The findings were concerning: over half of the participants had small cystic lesions averaging 6 mm in size, leading to seven endoscopic ultrasound procedures, four of which required biopsies. Remarkably, one biopsy revealed stage IB pancreatic ductal adenocarcinoma in a patient whose diabetes had recently deteriorated.

The study’s results also indicated a stark contrast between the two groups. Patients with deteriorating diabetes exhibited significantly higher A1c levels (P = 0.02), greater weight loss (P = 0.0038), and increased insulin requirements (P < 0.0001) compared to those with new-onset diabetes. The Enriching New-Onset Diabetes for Pancreatic Cancer score further illustrated the disparity, revealing that 75% of the deteriorating diabetes group fell into a high-risk category, compared to only 35.6% of the new-onset diabetes group.

Dr. Frank emphasized the significance of these findings, stating, "Preliminary results from the PANDOME study support further MRI-based pancreatic cancer screening research efforts in individuals with new-onset and deteriorating diabetes."

Despite these promising results, the study faced several limitations, including low participant accrual rates attributed to healthcare network realignments and a high declination rate among potential participants. Notably, a selection bias was observed, as the majority of participants (83%) were White, which raises concerns regarding the generalizability of the findings, particularly given the higher pancreatic cancer risk among Black populations.

This research was backed by various organizations, including the Tribute to Pamela/The Naughton Family Fund and the Glenn W. Bailey Foundation. The study’s authors declared no conflicts of interest, ensuring the integrity of the research. The implications of this study are profound, as early detection remains critical in improving survival outcomes for pancreatic cancer patients.

As the medical community continues to explore innovative screening methods, the need for targeted approaches in high-risk populations, particularly the elderly with diabetes, remains paramount. The PANDOME study may pave the way for future research and potential changes in clinical practice concerning pancreatic cancer screening protocols.