Established type-2 diabetes mellitus (HbA1c ≥6.5% on two occasions, or established T2DM d...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-CHRONIC-T2DM-CANCER-RISK-PREVENTION`
Type	Red flag
Status	reviewed 2026-05-19 \| pending_clinical_signoff
Diseases	`DIS-BREAST` `DIS-CRC` `DIS-ENDOMETRIAL` `DIS-HCC` `DIS-PDAC`
Sources	`SRC-AASLD-HCC-2023` `SRC-ESGO-ENDOMETRIAL-2025` `SRC-NCCN-BREAST-2025` `SRC-USPSTF-BREAST-2024` `SRC-USPSTF-CRC-2021`

Red Flag Origin

Definition	Established type-2 diabetes mellitus (HbA1c ≥6.5% on two occasions, or established T2DM diagnosis on oral hypoglycemics/insulin) confers modest but reproducible increases in risk for several cancers: pancreatic adenocarcinoma (RR ~1.8-2.0; up to 2.5 for recent-onset T2DM aged >50, where new-onset T2DM may be a presenting feature of occult pancreatic cancer — Pannala et al. JAMA 2008), colorectal cancer (RR ~1.3-1.4), hepatocellular carcinoma in NAFLD/MASLD-driven cirrhosis (RR ~2-3 multiplicative with NAFLD), endometrial cancer (RR ~2.1; particularly with obesity), and post-menopausal breast cancer (RR ~1.2-1.3). Putative mechanisms: hyperinsulinemia/IGF-1 axis, chronic inflammation, hyperglycemia favoring tumor metabolism, shared obesity/sedentary exposures. Risk modifiable: glycemic control, weight management, metformin (observational signal for reduced cancer incidence), physical act...
Clinical direction	investigate
Category	other

Trigger Logic

{
  "any_of": [
    {
      "finding": "type_2_diabetes_established",
      "value": true
    },
    {
      "finding": "hba1c_ge_6_5_repeat",
      "value": true
    },
    {
      "finding": "t2dm_on_pharmacotherapy",
      "value": true
    },
    {
      "finding": "new_onset_t2dm_age_ge_50",
      "value": true
    }
  ],
  "type": "lab_value"
}

Notes

Prevention-persona RedFlag for type-2 diabetes mellitus as multi-organ modest cancer risk amplifier. New-onset T2DM ≥50 with weight loss has ~1% absolute 3-year risk of pancreatic cancer — actionable surveillance signal (EUS or MR-pancreas in high-risk subset per ACG 2022). Other cancer-risk contributions are background and modify population-screening adherence rather than triggering off-schedule imaging. STUB pending two-Co-Lead signoff per CHARTER §6.1 dev-mode.

Used By

Indications

IND-CHRONIC-T2DM-CANCER-RISK-PREVENTION-OBSERVATION - IND-CHRONIC-T2DM-CANCER-RISK-PREVENTION-OBSERVATION
IND-CHRONIC-T2DM-CANCER-RISK-PREVENTION-SURVEILLANCE - IND-CHRONIC-T2DM-CANCER-RISK-PREVENTION-SURVEILLANCE