TAIWAN. Pancreatic adenocarcinoma is the most deadly of cancers with a five-year survival of only 5%. Furthermore, both the incidence and mortality are increasing and it is now the fourth leading cause of cancer deaths in the US. The problem is clear when one considers that the development is silent and 85% of the tumors are unresectable at diagnosis. Given this picture, prevention becomes paramount. Type 2 diabetes along with chronic hyperinsulinemia and hyperglycemia are recognized risk factors.

A recent study has clarified the dose (circulating level) relationship between blood sugar and risk. Nine studies were identified for analysis with a total of about 2400 patients with pancreatic cancer. It was found that there was a strong linear dose response association between fasting blood glucose (FBG) and the rate of pancreatic cancer across the range of prediabetes and diabetes. An increase in the rate ratio of 1.15 was found for per 0.56 mmol/L (10 mg/dL) increase in FBG. Perspective can be gained by considering that the threshold for prediabetes is 5.7 mmol/L and 7 mmol/L for diabetes. Progression from prediabetes to diabetes and then steadily increasing FBG for many underscores the problem for many individuals.

Liao WC, Tu YK, Wu MS, Lin JT, Wang HP, Chien KL. Blood glucose concentration and risk of pancreatic cancer: systematic review and dose-response meta-analysis. BMJ 2015;349:g7371