European Journal of Epidemiology

, Volume 34, Issue 3, pp 259–265 | Cite as

Cancer incidence among Finnish people with type 2 diabetes during 1989–2014

  • Katri SaarelaEmail author
  • Jaakko Tuomilehto
  • Reijo Sund
  • Ilmo Keskimäki
  • Sirpa Hartikainen
  • Eero Pukkala


Diabetes and cancer are common diseases both with enormous impact on health burden globally. The increased risk of several types of cancer among people with type 2 diabetes mellitus has been indicated repeatedly. This study aimed at exploring and describing the association between type 2 diabetes and cancer incidence. A cohort of 428,326 people with type 2 diabetes was identified from the Finnish National Diabetes Register and followed up through a register linkage with the Finnish Cancer Registry for cancer incidence during 1988–2014. A total of 74,063 cases of cancer occurred in this cohort in 4.48 million person-years. This accounted for 16% more than the expected cancer incidence in the Finnish general population; the standardized incidence ratio (SIR) was 1.16 (95% confidence interval [CI] 1.15–1.16). There was a statistically significant excess of cancers of lip (SIR = 1.40, CI = 1.28–1.53), liver (SIR = 2.44, CI = 2.35–2.53), pancreas (SIR = 1.75, CI = 1.70–1.79), stomach (SIR = 1.22, CI = 1.18–1.26), colon (SIR = 1.22, CI = 1.19–1.25), gallbladder and bile ducts (SIR = 1.29, CI = 1.21–1.36), non-melanoma skin (SIR = 1.18, CI = 1.15–1.22), kidney (SIR = 1.42, CI = 1.37–1.47), bladder (SIR = 1.17, CI = 1.13–1.21), and thyroid (SIR = 1.22, CI = 1.12–1.31). There was a small statistically significant decrease in prostate cancer incidence (SIR = 0.95, CI = 0.93–0.96). This study showed an association between type 2 diabetes mellitus and the incidence of cancer at numerous sites in the Finnish population.


Diabetes Cohort study Record linkage Cancer 



This study has been partly supported by the research Grants to JT from the Finnish Cancer Foundation, European Foundation for the Study of Diabetes and Sanofi-Aventis. JT is an advisory board member of Novo Nordisk and Merck KGaA. SH has received lecture fees from MSD.

Compliance with ethical standards

Conflict of interest

Authors KS, RS, IK and EP declare that they have no conflict of interest.


  1. 1.
    Tsilidis KK, Kasimis JC, Lopez DS, Ntzani EE, Ioannidis JPA. Type 2 diabetes and cancer: umbrella review of meta-analysis of observational studies. BMJ. 2015;350:g7607.CrossRefGoogle Scholar
  2. 2.
    Noto H, Tsujimoto T, Sasazuki T, Noda M. Significantly increased risk of cancer in patients with diabetes mellitus: a systematic review and meta-analysis. Endocr Pract. 2011;17:616–28.CrossRefGoogle Scholar
  3. 3.
    Gallagher EJ, LeRoith D. Obesity and diabetes: the increased risk of cancer and cancer-related mortality. Physiol Rev. 2015;95:727–48.CrossRefGoogle Scholar
  4. 4.
    Harding JL, Shaw JE, Peeters A, Carstensen B, Magliano DJ. Cancer risk among people with type 1 and type 2 diabetes: disentangling truth associations, detection bias, and reverse causation. Diabetes Care. 2015;38:264–70.CrossRefGoogle Scholar
  5. 5.
    Song S, Wang B, Zhang X, et al. Long-term diabetes mellitus is associated with an increased risk of pancreatic cancer: a meta-analysis. PLoS ONE. 2015;10:e0134321.CrossRefGoogle Scholar
  6. 6.
    Zhang C, Yang G, Ling Y, Chen G, Zhou T. The early diagnosis of pancreatic cancer and diabetes: what’s the relationship? J Gastrointest Oncol. 2014;5:481–8.Google Scholar
  7. 7.
    Huxley R, Ansary-Moghaddam A, Berrington de González A, et al. Type-II diabetes and pancreatic cancer: a meta-analysis of 36 studies. Br J Cancer. 2005;92:2076–83.CrossRefGoogle Scholar
  8. 8.
    Giovannucci E, Harlan DM, Archer MC, et al. Diabetes and cancer: a consensus report. Diabetes Care. 2010;33:1674–85.CrossRefGoogle Scholar
  9. 9.
    Larsson SC, Orsini N, Wolk A. Diabetes mellitus and risk of colorectal cancer: a meta-analysis. J Natl Cancer Inst. 2005;97:1679–87.CrossRefGoogle Scholar
  10. 10.
    Hardefeldt PJ, Edirimanne S, Eslick GD. Diabetes increases the risk of breast cancer: a meta-analysis. Endocr Relat Cancer. 2012;19:793–803.CrossRefGoogle Scholar
  11. 11.
    Zhang ZH, Su PY, Hao JH, Sun YH. The role of preexisting diabetes mellitus on incidence and mortality of endometrial cancer: a meta-analysis of prospective cohort studies. Int J Gynecol Cancer. 2013;23:294–303.CrossRefGoogle Scholar
  12. 12.
    Bao C, Yang X, Xu W, et al. Diabetes mellitus and incidence and mortality of kidney cancer: a meta-analysis. J Diabetes Complicat. 2013;27:357–64.CrossRefGoogle Scholar
  13. 13.
    Bansal D, Bhansali A, Kapil G, Undela K, Tiwari P. Type 2 diabetes and risk of prostate cancer: a meta-analysis of observational studies. Prostate Cancer Prostatic Dis. 2013;16(151-8):S1.Google Scholar
  14. 14.
    Kasper JS, Giovannucci E. A meta-analysis of diabetes mellitus and the risk of prostate cancer. Cancer Epidemiol Biomark Prev. 2006;15:2056–62.CrossRefGoogle Scholar
  15. 15.
    Johnson JA, Carstensen B, Witte D, et al. Diabetes and cancer (1): evaluating the temporal relationship between type 2 diabetes and cancer incidence. Diabetologia. 2012;55:1607–18.CrossRefGoogle Scholar
  16. 16.
    Vigneri P, Frasca F, Sciacca L, Pandini G, Vigneri R. Diabetes and cancer. Endocr Relat Cancer. 2009;16:1103–23.CrossRefGoogle Scholar
  17. 17.
    Xu H, Jiang HW, Ding GX, et al. Diabetes mellitus and prostate cancer risk of different grade or stage: a systematic review and meta-analysis. Diabetes Res Clin Pract. 2013;99:241–9.CrossRefGoogle Scholar
  18. 18.
    Tokajuk A, Krzyżanowska-Grycel E, Tokajuk A, Grycel S, Sadowska A, Car H. Antidiabetic drugs and risk of cancer. Pharmacol Rep. 2015;67:1240–50.CrossRefGoogle Scholar
  19. 19.
    Ioannidis JP, Zhou Y, Chang CQ, Schully SD, Khoury MJ, Freedman AN. Potential increased risk of cancer from commonly used medications: an umbrella review of meta-analyses. Ann Oncol. 2014;25:16–23.CrossRefGoogle Scholar
  20. 20.
    Karlstad Ø, Starup-Linde J, Vestergaard P, et al. Use of insulin and insulin analogs and risk of cancer—systematic review and meta-analysis of observational studies. Curr Drug Saf. 2013;8:333–48.CrossRefGoogle Scholar
  21. 21.
    Yang T, Yang Y, Liu S. Association between metformin therapy and breast cancer incidence and mortality: evidence from a meta-analysis. J Breast Cancer. 2015;18:264–70.CrossRefGoogle Scholar
  22. 22.
    Gandini S, Puntoni M, Heckman-Stoddard BM, et al. Metformin and cancer risk and mortality: a systematic review and meta-analysis taking into account biases and confounders. Cancer Prev Res (Phila). 2014;7:867–85.CrossRefGoogle Scholar
  23. 23.
    Sund R, Koski S. FinDM II. On the register-based measurement of the prevalence and incidence of diabetes and its long-term complications. A technical report. Tampere: Finnish Diabetes Association; 2009.Google Scholar
  24. 24.
    Sund R, Harno K, Ranta S, Tolppala EP. Comparing the case inclusion in two population-based diabetes registers. Finn J eHealth eWelfare. 2010;2:136–46.Google Scholar
  25. 25.
    Wang P, Kang D, Cao W, Wang Y, Liu Z. Diabetes mellitus and risk of hepatocellular carcinoma: a systematic review and meta-analysis. Diabetes Metab Res Rev. 2012;28:109–22.CrossRefGoogle Scholar
  26. 26.
    Raff EJ, Kakati D, Bloomer JR, Shoreibah M, Rasheed K, Singal AK. Diabetes mellitus predicts occurrence of cirrhosis and hepatocellular cancer in alcoholic liver and non-alcoholic fatty liver diseases. J Clin Transl Hepatol. 2015;3:9–16.CrossRefGoogle Scholar
  27. 27.
    Tudzarova S, Osman MA. The double trouble of metabolic diseases: the diabetes-cancer link. Mol Biol Cell. 2015;26:3129–39.CrossRefGoogle Scholar
  28. 28.
    Larsson SC, Wolk A. Diabetes mellitus and incidence of kidney cancer: a meta-analysis of cohort studies. Diabetologia. 2011;54:1013–8.CrossRefGoogle Scholar
  29. 29.
    De Bruijin KM, Arends LR, Hansen BE, Leeflang S, Ruiter R, van Eijck CH. Systematic review and meta-analysis of the association between diabetes mellitus and incidence and mortality in breast and colorectal cancer. Br J Surg. 2013;100:1421–9.CrossRefGoogle Scholar
  30. 30.
    Liao C, Zhang D, Mungo C, Tompkins DA, Zeidan AM. Is diabetes mellitus associated with increased incidence and disease-specific mortality in endometrial cancer? A systematic review and meta-analysis of cohort studies. Gynecol Oncol. 2014;135:163–71.CrossRefGoogle Scholar
  31. 31.
    Luo J, Beresford S, Chen C, et al. Association between diabetes, diabetes treatment and risk of developing endometrial cancer. Br J Cancer. 2014;111:1432–9.CrossRefGoogle Scholar
  32. 32.
    Pukkala E. Biobanks and registers in epidemiologic research on cancer. Methods Mol Biol. 2011;675:127–64.CrossRefGoogle Scholar
  33. 33.
    Katzke VA, Kaaks R, Kühn T. Lifestyle and cancer risk. Cancer J. 2015;21:104–10.CrossRefGoogle Scholar
  34. 34.
    Pukkala E, Martinsen JI, Lynge E, et al. Occupation and cancer—follow-up of 15 million people in five Nordic countries. Acta Oncol. 2009;48:646–790.CrossRefGoogle Scholar
  35. 35.
    Kim YJ, Jeon JY, Han SJ, Kim HJ, Lee KW, Kim DJ. Effect of socio-economic status on the prevalence of diabetes. Yonsei Med J. 2015;56:641–7.CrossRefGoogle Scholar
  36. 36.
    Lammi N, Taskinen O, Moltchanova E, et al. A high incidence of type 1 diabetes and an alarming increase in the incidence of type 2 diabetes among young adults in Finland between 1992 and 1996. Diabetologia. 2007;50:1393–400.CrossRefGoogle Scholar
  37. 37.
    Gordon-Dseagu VL, Mindell JS, Steptoe A, et al. Impaired glucose metabolism among those with and without diagnosed diabetes and mortality: a cohort study using Health Survey for England data. PLoS ONE. 2015;10:e0119882.CrossRefGoogle Scholar
  38. 38.
    Shikata K, Ninomiya T, Kiyohara Y. Diabetes mellitus and cancer risk: review of the epidemiological evidence. Cancer Sci. 2013;104:9–14.CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  1. 1.Chronic Disease Prevention UnitNational Institute for Health and WelfareHelsinkiFinland
  2. 2.Department of Public HealthUniversity of HelsinkiHelsinkiFinland
  3. 3.Dasman Diabetes InstituteDasmanKuwait
  4. 4.Diabetes Research GroupKing Abdulaziz UniversityJeddahSaudi Arabia
  5. 5.Department of Social ResearchUniversity of HelsinkiHelsinkiFinland
  6. 6.Institute of Clinical MedicineUniversity of Eastern FinlandKuopioFinland
  7. 7.Faculty of Social SciencesUniversity of TampereTampereFinland
  8. 8.Department of Health and Social Care SystemsNational Institute for Health and WelfareHelsinkiFinland
  9. 9.School of PharmacyUniversity of Eastern FinlandKuopioFinland
  10. 10.Finnish Cancer RegistryInstitute for Statistical and Epidemiological Cancer ResearchHelsinkiFinland

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