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Diabetes and risk of bladder cancer among postmenopausal women in the Iowa women’s health study

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Abstract

Purpose

Studies have indicated that diabetes is a risk factor for bladder cancer; however, many failed to adjust for confounding variables. An earlier publication from the Iowa Women’s Health Study reported a positive association of baseline diabetes with bladder cancer risk between 1986 and 1998, although the number of cases was small (n = 112). We re-examined the diabetes–bladder cancer risk association by accounting for 12 more years of follow-up and assessed whether the association varied by diabetes duration, body mass index, or waist-to-hip ratio (WHR).

Methods

Proportional hazards regression was used to estimate the hazard ratio (HR) of bladder cancer (n = 277) in relation to diabetes (before enrollment and during follow-up) and diabetes duration using a time-dependent approach.

Results

In a multivariate time-dependent analysis, the HR for bladder cancer was 1.69 (95 % CI 1.40–2.41) in relation to diabetes among 37,327 postmenopausal women initially free of cancer. There was an interaction between diabetes and WHR (p = 0.01). Bladder cancer HR in diabetic women with WHR > 0.9 was 2.5 times higher than expected. There was no dose–response relation of bladder cancer risk with diabetes duration. Compared to no diabetes, HRs were 1.77, 2.03, and 1.55 for diabetes durations of ≤5, 6–10, and >10 years, respectively.

Conclusions

We confirmed a positive association between diabetes and bladder cancer risk among white postmenopausal women. We also observed a synergistic interaction between diabetes and high WHR in bladder cancer development that might be explained by increased insulin resistance and inflammation related to abdominal obesity.

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References

  1. American Cancer Society (2012) Cancer facts & figures 2012. American Cancer Society, Atlanta

    Google Scholar 

  2. World Cancer Research Fund/American Institute for Cancer Research (2007) Food, nutrition, physical activity and the prevention of cancer: a global perspective. AICR, Washington DC

  3. Freedman N, Silverman D, Hollenbeck A, Schatzkin A, Abnet C (2011) Association between smoking and risk of bladder cancer among men and women. JAMA (Chicago, IL) 306:737–745

  4. Silverman DT, Devesa SS, Moore LE, Rothman N (2006) Bladder cancer. In: Schottenfeld D, Fraumeni JFJ (eds) Cancer epidemiology and prevention. Oxford University Press, New York, pp 1101–1128

    Chapter  Google Scholar 

  5. Larsson S, Orsini N, Brismar K, Wolk A (2006) Diabetes mellitus and risk of bladder cancer: a meta-analysis. Diabetologia 49:2819–2823

    Article  PubMed  CAS  Google Scholar 

  6. Tripathi A, Folsom A, Anderson K (2002) Risk factors for urinary bladder carcinoma in postmenopausal women. The Iowa Women’s Health Study. Cancer 95:2316–2323

    Article  PubMed  Google Scholar 

  7. Folsom AR, Kaye SA, Sellers TA et al (1993) Body fat distribution and 5-year risk of death in older women. JAMA 269:483–487

    Article  PubMed  CAS  Google Scholar 

  8. Bisgard KM, Folsom AR, Hong CP, Sellers TA (1994) Mortality and cancer rates in nonrespondents to a prospective study of older women: 5-year follow-up. Am J Epidemiol 139:990–1000

    PubMed  CAS  Google Scholar 

  9. Fritz A, Percy C, Jack A (2000) International classification of disease for oncology (ICD-O), 3rd edn. WHO, Geneva

    Google Scholar 

  10. Anderson KE, Anderson E, Mink PJ et al (2001) Diabetes and endometrial cancer in the Iowa women’s health study. Cancer Epidemiol Biomarkers Prev 10:611–616

    PubMed  CAS  Google Scholar 

  11. Limburg P, Anderson K, Johnson T et al (2005) Diabetes mellitus and subsite-specific colorectal cancer risks in the Iowa women’s health study. Cancer Epidemiol Biomarkers Prev 14:133–137

    PubMed  Google Scholar 

  12. Allison PD (2010) Survival analysis using SAS: a practical guide. SAS Institute

  13. ACSM’S Health-Related Physical Fitness Assessment Manual (2008) 2nd edn. Lippincott Williams & Wilkins, Philadelphia, p 59

  14. Johnson JA, Carstensen B, Witte D, Bowker SL, Lipscombe L, Renehan AG (2012) Diabetes and cancer (1): evaluating the temporal relationship between type 2 diabetes and cancer incidence. Diabetologia 55:1607–1618

    Article  PubMed  CAS  Google Scholar 

  15. Colmers I, Bowker S, Majumdar S, Johnson J (2012) Use of thiazolidinediones and the risk of bladder cancer among people with type 2 diabetes: a meta-analysis. Can Assoc Med 184:E675–E683

    Article  Google Scholar 

  16. Tseng C (2012) Pioglitazone and bladder cancer: a population-based study of Taiwanese. Diabetes Care 35:278–280

    Article  PubMed  CAS  Google Scholar 

  17. Mamtani R, Haynes K, Bilker W et al (2012) Association between longer therapy with thiazolidinediones and risk of bladder cancer: a cohort study. J Natl Cancer Inst 104:1411–1421

    Article  PubMed  CAS  Google Scholar 

  18. Onitilo A, Engel J, Glurich I, Stankowski R, Williams G, Doi S (2012) Diabetes and cancer II: role of diabetes medications and influence of shared risk factors. Cancer Causes Control 23:991–1008

    Article  PubMed  Google Scholar 

  19. Evans JMM (2005) Metformin and reduced risk of cancer in diabetic patients. Br Med J 330:1304–1305

    Article  Google Scholar 

  20. Atchison E, Gridley G, Carreon JD, Leitzmann M, McGlynn K (2011) Risk of cancer in a large cohort of U.S. veterans with diabetes. Int J Cancer 128:635–643

    Article  PubMed  CAS  Google Scholar 

  21. Larsson S, Andersson S, Johansson J, Wolk A (2008) Diabetes mellitus, body size and bladder cancer risk in a prospective study of Swedish men. Eur J Cancer 44:2655–2660

    Article  PubMed  Google Scholar 

  22. Noto H, Osame K, Sasazuki T, Noda M (2010) Substantially increased risk of cancer in patients with diabetes mellitus: a systematic review and meta-analysis of epidemiologic evidence in Japan. J Diabetes Complicat 24:345–353

    Article  PubMed  Google Scholar 

  23. Newton C, Gapstur S, Campbell P, Jacobs E (2012) Type 2 diabetes mellitus, insulin use, and risk of bladder cancer in a large cohort study. Int J Cancer. doi:10.1002/ijc.27878

  24. MacKenzie T, Zens M, Ferrara A, Schned A, Karagas M (2011) Diabetes and risk of bladder cancer: evidence from a case–control study in New England. Cancer 117:1552–1556

    Article  PubMed  Google Scholar 

  25. Tseng CH (2011) Diabetes and risk of bladder cancer: a study using the national health insurance database in Taiwan. Diabetologia 54:2009–2015

    Article  PubMed  Google Scholar 

  26. Woolcott C, Maskarinec G, Haiman C, Henderson B, Kolonel L (2011) Diabetes and urothelial cancer risk: the multiethnic cohort study. Cancer Epidemiol 35:551–554

    Article  PubMed  Google Scholar 

  27. Vigneri P, Frasca F, Sciacca L, Pandini G, Vigneri R (2009) Diabetes and cancer. Endocr Relat Cancer 16:1103–1123

    Article  PubMed  CAS  Google Scholar 

  28. Giovannucci E, Harlan DM, Archer MC et al (2010) Diabetes and cancer: a consensus report. CA Cancer J Clin 60:207–221

    Article  PubMed  Google Scholar 

  29. Dunn SE, Kari FW, French J et al (1997) Dietary restriction reduces insulin-like growth factor I levels, which modulates apoptosis, cell proliferation, and tumor progression in p53-deficient mice. Cancer Res 57:4667–4672

    PubMed  CAS  Google Scholar 

  30. Zhao H, Grossman HB, Spitz M, Lerner S, Zhang K, Wu X (2003) Plasma levels of insulin-like growth factor-1 and binding protein-3, and their association with bladder cancer risk. J Urol 169:714–717

    Article  PubMed  CAS  Google Scholar 

  31. Jiang X, Castelao JE, Groshen S et al (2009) Urinary tract infections and reduced risk of bladder cancer in Los Angeles. Br J Cancer 100:834–839

    Article  PubMed  CAS  Google Scholar 

  32. Sinha MK, Ohannesian JP, Heiman ML et al (1996) Nocturnal rise of leptin in lean, obese, and non-insulin-dependent diabetes mellitus subjects. J Clin Invest 97:1344–1347

    Article  PubMed  CAS  Google Scholar 

  33. Saxena M, Agrawal C, Gautam S, Bid H, Banerjee M (2009) Overt diabetic complications in obese Type 2 diabetes mellitus patients from North India. Arch Appl Sci Res 1:57–66

    Google Scholar 

  34. Simpson C, Boyd C, Carlson M, Griswold M, Guralnik J, Fried L (2004) Agreement between self-report of disease diagnoses and medical record validation in disabled older women: factors that modify agreement. J Am Geriatr Soc 52:123–127

    Article  PubMed  Google Scholar 

  35. Kaye SA, Folsom AR, Sprafka JM, Prineas RJ, Wallace RB (1991) Increased incidence of diabetes mellitus in relation to abdominal adiposity in older women. J Clin Epidemiol 44:329–334

    Article  PubMed  CAS  Google Scholar 

  36. Centers for Disease Control and Prevention (CDC) (2011) National diabetes fact sheet, 2011. http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf. Accessed May 2012

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Acknowledgments

The authors are thankful to the IWHS staff for consultation and assistance in data preparation. This study was supported by National Cancer Institute grant R01 CA39742. A.E. Prizment was supported as a postdoctoral fellow by the National Cancer Institute (T32CA132670).

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Authors and Affiliations

  1. Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S. Second Street, Suite 300, Minneapolis, MN, 55454-1015, USA

    Anna E. Prizment, Kristin E. Anderson & Aaron R. Folsom

  2. University of Minnesota Masonic Cancer Center, University of Minnesota, 425 East River Road, Minneapolis, MN, 55545, USA

    Kristin E. Anderson & Aaron R. Folsom

  3. Division of Cancer Control and Population Sciences, University of Pittsburgh Cancer Institute, Pittsburgh, PA, 15232, USA

    Jian-Min Yuan

  4. Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 5150 Centre Avenue, Pittsburgh, PA, 15232, USA

    Jian-Min Yuan

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  1. Anna E. Prizment
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  2. Kristin E. Anderson
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  3. Jian-Min Yuan
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  4. Aaron R. Folsom
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Correspondence to Anna E. Prizment.

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Prizment, A.E., Anderson, K.E., Yuan, JM. et al. Diabetes and risk of bladder cancer among postmenopausal women in the Iowa women’s health study. Cancer Causes Control 24, 603–608 (2013). https://doi.org/10.1007/s10552-012-0143-3

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  • DOI: https://doi.org/10.1007/s10552-012-0143-3

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