Rise in pancreatic cancer cases among young adults may be overdiagnosis

Embargoed for release until 5:00 p.m. ET on Monday 18 November 2024    

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Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.         
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1. Rise in pancreatic cancer cases among young adults may be overdiagnosis  

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-00635 

URL goes live when the embargo lifts          

An analysis of pancreatic cancer data in younger adults found that while there is an increasing incidence of pancreatic cancer in young adults, the mortality rate remains stable. This increased incidence seems to be due to increased detection of smaller, early-stage endocrine cancer, rather than an increase in pancreatic adenocarcinoma, suggesting the possibility of overdiagnosis. These findings are published in Annals of Internal Medicine.  

Researchers from Brigham and Women’s Hospital studied data from the U.S Cancer Statistics database and the National Vital Statistics System to examine the incidence, tumor size, stage distribution, and disease-specific mortality of pancreatic cancer in men and women aged 15 to 39 years from 2001 to 2019 to determine whether the observed increase in incidence of pancreatic cancer among young Americans represents a true increase in cancer occurrence. The researchers defined four different histologic categories (adenocarcinoma, endocrine, solid pseudopapillary, and other) and investigated variables including tumor size and receipt of cancer-directed surgery. The researchers found that between 2001 and 2019, pancreatic cancer incidence increased among both men and women, and the rate of cancer-directed pancreatic surgery more than doubled in both men and women. The increase in incidence was attributable mostly to early-stage cancer, with the incidence of small tumors increasing from 0.22 to 1.8 per million in women and 0.33 to 1 per million in men. The increase in incidence was not attributable to the dominant pancreatic cancer histology of adenocarcinoma, but rather to endocrine cancer and solid pseudopapillary neoplasms. 

While there have been several reports in recent years raising concerns over the increase of pancreatic cancer among young people, this analysis indicates that the increase in incidence is primarily due to increased detection of smaller, early-stage endocrine cancer. Stable mortality rates despite increases in incidence suggest the detection of previously undetected disease rather than an increase in actual pancreatic cancer occurrence. The researchers warn that pancreatic cancer can be overdiagnosed – particularly when the different types of pancreatic cancer are lumped together – leading to an increase in high-risk pancreatic surgery. 

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the first author Vishal R. Patel, MD, please contact Alison Kou, MPH at akou@bwh.harvard.edu

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2. Rapid increase in Oropouche virus in Western hemisphere has infectious disease experts on high alert

Health officials warn that the vector-borne illness has potential for sexual transmission  

Abstract: https://www.acpjournals.org/ANNALS-24-03049  

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A rapid increase in cases of Oropouche virus (OROV) in the Western hemisphere has infectious disease experts on high alert. The authors of a commentary published in Annals of Internal Medicine warn that OROV disease has the potential to become a global public health threat. With no current vaccine or treatment, it is critical for physicians to be aware of the of OROV and its potential to spread through sexual transmission.

OROV is a virus spread primarily through biting midges but can also be spread through some mosquitoes. The incubation period is between 3─10 days, followed by symptoms that typically last 2-7 days, but nearly 40% of patients may remain asymptomatic. OROV disease case reports dramatically increased in 2024 across the Americas, and as of October 10th, US Centers for Disease Control and Prevention (CDC) has reported 90 cases in U.S. travelers following travel from Cuba. The CDC has issued a Level 2 Health Notice for Cuba to inform travelers about the disease and take precautions against insect bites. 

Although insect bites are the primary mode of transmission of OROV, health officials are now warning against the potential for sexual transmission of the virus reminiscent of non-vector transmission of Zika, as replication-competent OROV was detected in the semen of a 42-year-old Italian traveler returning from Cuba. Commercial testing is not yet available for OROV, posing a significant setback in case reporting and surveillance of the virus. The authors share several recommendations for physicians to mitigate the spread of OROV including counseling patients on the possible risks of vertical and sexual transmission and advising pregnant patients to reconsider travel to areas with large outbreaks. 

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author Davidson H. Hamer, MD, please email Cassandra Kocek at ckocek@bu.edu.

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3. Denosumab increases risk of emergently treated hypocalcemia in advanced chronic kidney disease

Abstract: https://www.acpjournals.org/M24-0013

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A target trial emulation evaluated the incidence of emergently treated hypoalcemia associated with denosumab by stage of chronic kidney disease (CKD) progression and presence of CKD-mineral and bone disorder (CKD-MBD). The data revealed that the risk of emergently treated hypocalcemia increased with worsening CKD stage, with dialysis-dependent patients and those with CKD-MBD at the highest risk. The study is published in Annals of Internal Medicine.

Researchers from the Food and Drug Administration (FDA) and Centers for Medicare and Medicaid Services (CMS) studied data for female Medicare beneficiaries aged 65 years and older with CKD initiating denosumab, oral bisphosphonates, or intravenous bisphosphonates for osteoporosis between 2012 to 2020. The authors sought to assess the risk for emergently treated hypocalcemia with denosumab by stage of CKD and presence of CKD-MBD. The researchers found that increased risk of emergently treated hypocalcemia with denosumab appeared within 1 week after denosumab administration, peaked at week 2 and persisted for approximately 10 weeks, compared with oral bisphosphonates. As CKD stage progressed, so did the risk of denosumab-induced emergently treated hypocalcemia, with a notable increased risk for both non-dialysis dependent and dialysis dependent patients with late-stage CKD. Among those with late-stage CKD, those with CKD-MBD were at a greater risk for emergently treated hypocalcemia with denosumab vs. oral bisphosphonates. Denosumab also showed increased risk compared to intravenous bisphosphonates. According to the researchers, there is a scarcity of data on the treatment of osteoporosis in patients with advanced CKD, despite osteoporosis and CKD being common comorbidities. These findings suggest that injectable therapies like denosumab may not be effective in the management of osteoporosis in patients with advanced CKD and CKD-MBD.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author Steven Bird, PhD, PharmD, please email steven.bird@fda.hhs.gov.   

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Also new in this issue:

Illuminating the Value of Palliative Care in Cancer: A Path to Incentivizing High-Value Cancer Care

Xin Hu, PhD; Boshen Jiao, PhD; Xiaoyu Pan, MD, PhD, MPH; Ryan Nipp, MD, MPH; and Changchuan Jiang, MD, MPH

Ideas and Opinions

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-00702

Information Disclosure, Medical Device Regulation, and Device Safety: The Case of Cook Celect IVC Filters

Kushal T. Kadakia, MSc; Behnood Bikdeli, MD, MS; Aakriti Gupta, MD; Sanket S. Dhruva, MD, MHS; Joseph S. Ross, MD, MHS; and Harlan M. Krumholz, MD, SM

Medicine and Public Issues

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-00089

Peer Review: Insights Gleaned From Observing the Editorial Process at Annals of Internal Medicine

Yuri Matusov, MD; Taylor Brooks, MD; Desiree Burroughs-Ray, MD, MPH; and Maniraj Neupane, MD, PhD

Ideas and Opinions

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-01737