Kim SH. New-onset diabetes and pancreatic cancer: Current evidence on absolute risk and screening feasibility. World J Gastrointest Oncol 2026; 18(7): 121817 [DOI: 10.4251/wjgo.v18.i7.121817]
Corresponding Author of This Article
Seoung Hoon Kim, MD, PhD, Senior Scientist, Organ Transplantation Center, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, South Korea. kshlj@hanmail.net
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Oncology
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Kim SH. New-onset diabetes and pancreatic cancer: Current evidence on absolute risk and screening feasibility. World J Gastrointest Oncol 2026; 18(7): 121817 [DOI: 10.4251/wjgo.v18.i7.121817]
World J Gastrointest Oncol. Jul 15, 2026; 18(7): 121817 Published online Jul 15, 2026. doi: 10.4251/wjgo.v18.i7.121817
New-onset diabetes and pancreatic cancer: Current evidence on absolute risk and screening feasibility
Seoung Hoon Kim
Seoung Hoon Kim, Organ Transplantation Center, National Cancer Center, Goyang 10408, South Korea
Author contributions: Kim SH conceived the study, performed the literature review, wrote the manuscript, and approved the final version.
AI contribution statement: No generative AI tool was used to generate the manuscript content, scientific interpretation, conclusions, references, tables, or figures. The author prepared the manuscript, selected and interpreted the literature, independently verified all references, and formatted references using EndNote. Google Translate was used only as an auxiliary tool for language editing and proofreading of selected English expressions. The manuscript was not entirely generated using translation software.
Conflict-of-interest statement: The author declares no conflict of interest.
Corresponding author: Seoung Hoon Kim, MD, PhD, Senior Scientist, Organ Transplantation Center, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, South Korea. kshlj@hanmail.net
Received: April 2, 2026 Revised: May 13, 2026 Accepted: May 25, 2026 Published online: July 15, 2026 Processing time: 96 Days and 3.9 Hours
Abstract
Pancreatic ductal adenocarcinoma (PDAC) remains a highly lethal malignancy largely due to delayed diagnosis, prompting growing interest in early clinical signals that may facilitate earlier detection. New-onset diabetes (NOD) has emerged as one such signal, supported by accumulating epidemiologic evidence demonstrating a temporal association between diabetes onset and subsequent PDAC diagnosis. Recent large population-based studies have confirmed an increased relative risk of PDAC among individuals with glycemically defined NOD, particularly within the first few years after diabetes onset. However, despite this association, the absolute incidence of PDAC in NOD populations remains low, raising critical questions regarding the feasibility and clinical justification of population-wide screening strategies. This discrepancy between relative risk elevation and absolute event probability represents a central challenge in translating epidemiologic findings into actionable clinical practice. Risk stratification models, such as the Enriching NOD for Pancreatic Cancer score, have been proposed to address this gap, yet their real-world performance highlights persistent limitations when applied as stand-alone tools for diagnostic decision-making. This minireview synthesizes recent epidemiologic, modeling, and screening-related evidence to clarify the clinical role of NOD in PDAC detection. Current evidence supports viewing NOD as a gatekeeper for stepwise risk enrichment rather than a screening indication and favors risk-enriched, stepwise diagnostic strategies, with future work focused on prospective validation, integrated biomarkers, and actionable absolute-risk thresholds.
Core Tip: New-onset diabetes (NOD) is a reproducible clinical signal associated with pancreatic ductal adenocarcinoma, but its absolute cancer risk remains low. This minireview summarizes recent prospective cohort data, risk stratification models, and screening-related evidence showing why NOD should not be used as a screening indication. Instead, it should be considered a gatekeeper for stepwise risk enrichment, with future efforts focused on clinically actionable absolute-risk thresholds, biomarkers, and prospective validation.
