New-onset diabetes and pancreatic cancer: Current evidence on absolute risk and screening feasibility

Table 1 Contextualizing pancreatic cancer risk across screening-relevant populations

Population	Approximate risk context	Implication for screening
General population	Very low background incidence; population-level screening is not justified	No routine screening
Adults with glycemically defined NOD	Relative risk is increased, but absolute PDAC risk remains low, approximately around 1% over 3 years in older adults with NOD	Indiscriminate imaging of all NOD patients is inefficient
Enriched NOD subgroup	Risk increases with older age, weight loss, rapid glycemic worsening, or high END-PAC score	Candidate group for selective imaging or biomarker-based enrichment
Very high-risk clinical subgroup	NOD plus symptoms, abnormal biomarkers/imaging, hereditary risk, or strong clinical concern	Diagnostic evaluation rather than screening

END-PAC: Enriching new-onset diabetes for pancreatic cancer; NOD: New-onset diabetes; PDAC: Pancreatic ductal adenocarcinoma.