Cancer Causes & Control

, Volume 2, Issue 5, pp 307–314

Cancer risk in patients with diabetes mellitus

  • Hans-Olov Adami
  • Joseph McLaughlin
  • Anders Ekbom
  • Christian Berne
  • Debra Silverman
  • David Hacker
  • Ingemar Persson
Research Paper

Cancer incidence was ascertained in a population-based cohort of 51,008 patients in Uppsala, Sweden, who were given a discharge diagnosis of diabetes mellitus during 1965–83. Complete follow-up through 1984 with exclusion of the first year of observation showed that the observed number of cancers in females (1,294) was eight percent higher than expected (relative risk [RR]=1.1, 95 percent confidence interval =11.0–1.1), whereas in males the observed number (1,123) was close to the expected (RR=1.0, 0.9–1.1). Significantly increased risks of pancreatic (RR=1.4, 1.2–1.7), primary liver (RR=1.5, 1.2–1.7), and endometrial (RR=1.5, 1.2–1.8) cancers and a lower than expected number of prostatic cancers (RR=0.7, 0.7–09) were found in this cohort of diabetic patients. The excess risk of pancreatic cancer was similar in females and males and evident both during one through four years (RR=1.7, 1.4–2.1) and five through nine years (RR=1.3, 0.9−1.7) of follow-up, but not thereafter. A similar pattern was found for primary liver cancer, but the RRs were generally higher in males than in females.

Key words

Cancer risk cohort study diabetes Sweden 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    KesslerII, Cancer mortality among diabetics. JNCI 1970; 44: 673–86.Google Scholar
  2. 2.
    Wynder EL, Mabuchi K, Mabuchi N, Fortner JG. Epidemiology of cancer of the pancreas. JNCI 1973; 50: 645–67.Google Scholar
  3. 3.
    Ragozzino MW, MeltonIII JM, Chu CP, Palumbo JP. Subsequent cancer risk in the incidence cohort of Rochester, Minnesota, residents with diabetes mellitus. J Chronic Dis 1982; 35: 13–9.Google Scholar
  4. 4.
    Whittemore AS, Paffenberger RS, Anderson K, Halpern J. Early precursors of pancreatic cancer in college men. J Chronic Dis 1983; 36: 251–6.Google Scholar
  5. 5.
    O'Mara BA, Byers T, Schoenfeld E. Diabetes mellitus and cancer risk: a multisite case-control study. J Chronic Dis 1985; 38: 435–41.Google Scholar
  6. 6.
    Norell S, Ahlbom A, Erwald R, et al. Diabetes, gall stone disease, and pancreatic cancer (Letter). Br J Cancer 1986; 54: 377–8.Google Scholar
  7. 7.
    Hiatt RA, Klatsky AL, Armstrong MA. Pancreatic cancer, blood glucose and beverage consumption. Int J Cancer 1988; 41: 794–7.Google Scholar
  8. 8.
    Cuzick J, Babiker AG. Pancreatic cancer, alcohol, diabetes mellitus and gallbladder disease. Int J Cancer 1989; 43: 415–21.Google Scholar
  9. 9.
    Lawson DH, Gray JMB, McKillop C, Clarke J, Lee FD, Patrick RS. Diabetes mellitus and primary hepatocellular carcinoma. Q J Med 1986; 61: 945–55.Google Scholar
  10. 10.
    MacMahon B. Risk factors for endometrial cancer. Gynecol Oncol 1974; 2: 122–9.Google Scholar
  11. 11.
    Elwood JM, Cole P, Rothman KJ, Kaplan SD. Epidemiology of endometrial cancer. JNCI 1977; 59: 1055–60.Google Scholar
  12. 12.
    Lin RS, KesslerII. A multi-factorial model for pancreas cancer in man-epidemiologic evidence. JAMA 1981; 245: 147–52.Google Scholar
  13. 13.
    Goldstein HR. No association found between coffee and cancer of the pancreas (Letter). N Engl J Med 1982; 306: 997.Google Scholar
  14. 14.
    Heuch I, Kvå;le G, Jacobsen BK, Bjelke E Use of alcohol, tobacco and coffee, and risk of pancreatic cancer. Br J Cancer 1983; 48: 637–43.Google Scholar
  15. 15.
    Gold EB, Gordis L, Diener MD, et al. Diet and other risk factors for cancer of the pancreas. Cancer Res 1985; 55: 460–7.Google Scholar
  16. 16.
    Mack TM, Yu MC, Hanisch R, Henderson BE. Pancreas cancer and smoking, beverage consumption, and past medical history. JNCI 1986; 76: 49–60.Google Scholar
  17. 17.
    Dahlquist GG, Blom LG, Persson LÅ, Sandström AIM, Wall SGI. Dietary factors and the risk of developing insulin dependent diabetes in the childhood. Br Med J 1990; 300: 1302–6.Google Scholar
  18. 18.
    Drell DW, Notkins AL. Multiple immunological abnormalities in patients with type 1 (insulin-dependent) diabetes mellitus. Diabetologia 1987; 30: 132–43.Google Scholar
  19. 19.
    Reaven GM. Role of insulin resistance in human disease. Diabetes 1988; 37: 1595–607.Google Scholar
  20. 20.
    Barrett-Connor E, Khaw KT, Yen SS. Endogenous sex hormone levels in older adult men with diabetes mellitus. Am J Epidemiol 1990; 132: 895–901.Google Scholar
  21. 21.
    Naessén T, Parker R, Persson I, Zack M, Adami HO. Time trends in incidence rates of first hip fracture in the Uppsala Health Care Region, Sweden, 1965–1983. Am J Epidemiol 1989; 130: 289–99.Google Scholar
  22. 22.
    Swedish Cancer Registry. Cancer Incidence in Sweden 1965–1985 (Annual publications). Stockholm, Sweden: National Board of Health and Welfare, 1969–89.Google Scholar
  23. 23.
    BailarIII JC, Ederer P. Significance factors for the ratio of a Poisson variable to its expectation. Biometrics 1964; 20: 639–43.Google Scholar
  24. 24.
    Jain M, Howe GR, St. Louis P, Miller AB. Coffee and alcohol as determinants of risk of pancreas cancer: a case-control study from Toronto. Int J Cancer 1991; 47: 384–9.Google Scholar
  25. 25.
    Mack TM, Pancreas. In: Schottenfeld D, Fraumeni JFJr, eds., Cancer Epidemiology and Prevention. Philadelphia, PA: WB Saunders, 1982: 638–67.Google Scholar
  26. 26.
    Ben G, Gnudi L, Maran A, et al. Effects of chronic alcohol intake on carbohydrate and lipid metabolism in subjects with type II (non-insulin-dependent) diabetes mellitus. Am J Med 1991; 90: 70–6.Google Scholar
  27. 27.
    International Agency for Research on Cancer. Alcohol Drinking. Lyon, France: IARC 1988; IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Vol. 44.Google Scholar
  28. 28.
    Flyvbjerg A, Orskov H. Growth hormone, insulin-like growth factors and diabetes. In: Alberti KGMM, Krall LP, eds, The Diabetes Annual 5. Amsterdam: Elsevier Science Publishers, BV, 1990: 642–56.Google Scholar
  29. 29.
    Henderson JR, Daniel PM, Fraser P. A e pancreas as a single organ: The influence of the endocrine upon the exocrine part of the gland. Gut 1981; 22: 158–67.Google Scholar
  30. 30.
    Grill V, Gutniak M, Roovete A, Efendic S. A stimulating effect of glucose on somatostatin release is impaired in non-insulin-dependent diabetes mellitus. J Clin Endocrinol Metab 1984; 59: 293–7.Google Scholar
  31. 31.
    Lamberts SW, Krenning EP, Klljn JGM, Reubi JC. The clinical use of somatostatin analogues in the treatment of cancer. Baillière's Clin Endocrinol Metab 1990; 4: 29–49.Google Scholar
  32. 32.
    Liebow C, Hierowski M, Sapin K. Hormonal control of pancreatic cancer growth. Pancreas 1986; 1: 44–8.Google Scholar
  33. 33.
    Chou CK, Ho LT, Ting LP, et al. Selective suppression of insulin-induced proliferation of cultured human hepatoma cells by somatostatin. J Clin Invest 1987; 79: 175–8.Google Scholar
  34. 34.
    Kelsey JL, Hildreth NG. Breast and Gynecologic Cancer Epidemiology. Elorida: CRC Press Inc, 1983: 71–91.Google Scholar
  35. 35.
    Pettersson, B. Risk factors for endometrial carcinoma. A case-control study (Dissertation). Uppsala, Sweden: Aeta Universitatis Upsaliensis, 1985.Google Scholar
  36. 36.
    Grönroos M, Tyrkko J, Siiteri PK, Salmi T, Haataja M, Paul R. Cytolysis and karyopyknosis in postmenopausal vaginal smears as markers of endometrial cancer, diabetes and obesity. Studies based on a ten-year follow-up. Acta Cytol 1986; 30: 628–32.Google Scholar
  37. 37.
    Chodak GW, Schoenberg HW. Progress and problems in screening for carcinoma of the prostate. World J Surg 1989; 13: 60–4.Google Scholar
  38. 38.
    Ross RK, Paganini-Hill A, Henderson BE. Epidemiology of prostatic cancer. In: Skinner DG, Lieskovsky G, eds. Diagnosis and Management of Genitourinary Cancer. Philadelphia, PA: WB Saunders, 1988: 40–5.Google Scholar
  39. 39.
    Fushimi H, Horie H, Kameyama M, et al. Low testosterone levels in diabetic men and animals: a possible role in testicular impotence. Diabetes Res Clin Pract 1989; 6: 297–301.Google Scholar
  40. 40.
    Madsbad S, Gluud C, Bennett P, Krarup T. Rapid changes in plasma androgens during insulin withdrawal in male type 1 (insulin-dependent) diabetics. J Endocrinol Invest 1986; 9: 21–5.Google Scholar
  41. 41.
    Small M, MacRury S, Beastall GH, MacCuish AC. Oestradiol levels in diabetic men with and without previous myocardial infarction. Q J Med 1987; 64: 617–23.Google Scholar

Copyright information

© Rapid Communications of Oxford Ltd 1991

Authors and Affiliations

  • Hans-Olov Adami
  • Joseph McLaughlin
  • Anders Ekbom
  • Christian Berne
  • Debra Silverman
  • David Hacker
  • Ingemar Persson

There are no affiliations available

Personalised recommendations