Risk of cancer in a large cohort of U.S. veterans with diabetes.
Prior studies of cancer risk among diabetic men have reported inconsistent findings. The aim of this study was to assess the risk of cancer among a large cohort (n = 4,501,578) of black and white U.S. veterans admitted to Veterans Affairs hospitals. The cancer risk among men with diabetes (n = 594,815) was compared to the risk among men without diabetes (n = 3,906,763). Poisson regression was used to estimate adjusted relative risks (RRs) and 95% confidence intervals (CIs). Overall, men with diabetes had a significantly lower risk of cancer (RR = 0.93, 95%CI = 0.93-0.94). Men with diabetes, however, had increased risks of cancers of the liver (RR = 1.95, 95%CI = 1.82-2.09), pancreas (RR = 1.50, 95%CI = 1.42-1.59), biliary tract (RR = 1.41, 95%CI = 1.22-1.62), colon (RR = 1.20, 95%CI = 1.16-1.25), rectum (RR = 1.12, 95%CI = 1.07-1.18), and kidney (RR = 1.09, 95%CI = 1.03-1.16), as well as leukemia (RR = 1.14, 95%CI = 1.08-1.21) and melanoma (RR = 1.13, 95%CI = 1.03-1.24). In contrast, men with diabetes had decreased risks of cancers of the prostate (RR = 0.89, 95%CI = 0.87-0.91), brain (RR = 0.91, 95% CI = 0.82-0.99), buccal cavity (RR = 0.85, 95%CI = 0.82-0.89), lung (RR = 0.79, 95%CI = 0.77-0.80), esophagus (RR = 0.77, 95%CI = 0.72-0.82), and larynx (RR = 0.76, 95%CI = 0.71-0.80). These findings indicate that black and white men with diabetes are at significantly lower risk of total cancer and of two of the most common cancers among U.S. males; lung and prostate cancers. These decreased risks were offset, however, by increased risks of cancer at several sites. Hyperinsulinemia may explain the increased risks of the digestive cancers, while lower testosterone levels, in the case of prostate cancer, and higher BMI, in the case of lung cancer, may explain the decreased risks of those tumors.
Atchison
Elizabeth A
EA
Division of Cancer Epidemiology and Genetics, NCI, NIH, DHHS, Bethesda, MD, USA.
Gridley
Gloria
G
Carreon
J Daniel
JD
Leitzmann
Michael F
MF
McGlynn
Katherine A
KA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044383:Black People / Q000706:statistics & numerical data; D015992:Body Mass Index; D001932:Brain Neoplasms / Q000453:epidemiology; D016001:Confidence Intervals; D048909:Diabetes Complications / Q000453:epidemiology*; D004938:Esophageal Neoplasms / Q000453:epidemiology; D006801:Humans; D007938:Leukemia / Q000453:epidemiology; D008175:Lung Neoplasms / Q000453:epidemiology; D008297:Male; D008545:Melanoma / Q000453:epidemiology; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000453:epidemiology; D009369:Neoplasms / Q000453:epidemiology*; D011471:Prostatic Neoplasms / Q000453:epidemiology; D012306:Risk; D018570:Risk Assessment; D013739:Testosterone / Q000097:blood; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data; D001741:Black or African American
D013739:Testosterone
Cancer Causes Control. 2008 Sep;19(7):703-10
18340542
Lancet. 1970 Jan 31;1(7640):218-20
4189012
Int J Cancer. 2006 May 1;118(9):2293-7
16331628
Am J Epidemiol. 2004 Jun 15;159(12):1160-7
15191933
J Clin Epidemiol. 2001 Aug;54(8):802-9
11470389
J Natl Cancer Inst. 2000 Jul 5;92(13):1096-9
10880555
Int J Cancer. 1990 May 15;45(5):816-20
2335385
World J Gastroenterol. 2008 Oct 7;14(37):5695-700
18837086
Diabetologia. 1999 Jan;42(1):107-12
10027588
J Natl Cancer Inst. 1970 Mar;44(3):673-86
11515436
Cancer Epidemiol Biomarkers Prev. 2009 May;18(5):1350-6
19383895
Am J Epidemiol. 1990 Feb;131(2):254-62
2296978
J Natl Cancer Inst. 2003 Dec 3;95(23):1797-800
14652242
Ann Oncol. 2006 Sep;17(9):1459-63
16873426
Diabetes Care. 2006 Aug;29(8):1990-1
16873829
Cancer Res. 2002 Feb 15;62(4):1030-5
11861378
Hepatology. 2006 Dec;44(6):1408-10
17133479
Br J Prev Soc Med. 1976 Sep;30(3):151-7
974434
J Clin Endocrinol Metab. 2006 Jul;91(7):2562-8
16608892
Pancreatology. 2007;7(2-3):187-93
17592233
Diabetologia. 2004 Jun;47(6):1071-8
15164171
J Natl Cancer Inst. 1996 Oct 16;88(20):1472-7
8841022
Cancer Epidemiol Biomarkers Prev. 1995 Dec;4(8):807-11
8634649
Cancer Causes Control. 1991 Sep;2(5):307-14
1932543
JAMA. 1995 May 24-31;273(20):1605-9
7745774
Cancer Res. 1997 Nov 1;57(21):4787-94
9354440
Diabetes Care. 2004 Jan;27 Suppl 1:S74-5
14693932
J Natl Cancer Inst. 1997 Sep 17;89(18):1360-5
9308706
Int J Cancer. 2002 Nov 20;102(3):258-61
12397646
Am J Epidemiol. 2009 Apr 15;169(8):937-45
19240222
Cancer Causes Control. 1998 Jan;9(1):3-9
9486458
Br J Cancer. 2005 Jun 6;92(11):2076-83
15886696
J Chronic Dis. 1971 Jan;23(8):579-600
4933059
Arch Intern Med. 2006 Sep 25;166(17):1871-7
17000944
J Chronic Dis. 1982;35(1):13-9
7068798
Br J Cancer. 2009 Oct 6;101(7):1199-201
19690547
Hepatology. 2006 Jun;43(6):1295-302
16729295
Cancer Epidemiol Biomarkers Prev. 2006 Nov;15(11):2056-62
17119028
Cancer Epidemiol Biomarkers Prev. 2009 Jul;18(7):2079-89
19567501
J Nutr. 2001 Nov;131(11 Suppl):3109S-20S
11694656
J Natl Cancer Inst. 1995 Jun 21;87(12):930-1
7666483
Lancet. 2004 Apr 24;363(9418):1346-53
15110491
Am J Epidemiol. 1992 Nov 1;136(9):1110-4
1462971
J Epidemiol Community Health. 2002 Jun;56(6):479-80; author reply 480
12011210
Diabetes Care. 2001 Nov;24(11):1936-40
11679460
Am J Epidemiol. 2008 Jul 15;168(2):158-69
18483121
Cancer Epidemiol Biomarkers Prev. 2006 Aug;15(8):1458-63
16896032
J Natl Cancer Inst. 2002 Jul 3;94(13):972-80
12096082
Diabetes Care. 1998 Jul;21(7):1138-45
9653609
Cancer Invest. 2002;20(2):157-65
11901534
J Chronic Dis. 1985;38(5):435-41
3998058
Am J Epidemiol. 2003 Jun 15;157(12):1092-100
12796045
Cancer Res. 1990 Jan 1;50(1):103-7
2152769
J Natl Cancer Inst. 1991 Dec 18;83(24):1820-6
1660542
Br J Cancer. 2001 Feb 2;84(3):417-22
11161410
Int J Cancer. 2006 Apr 15;118(8):2105-9
16284945
Br J Cancer. 1994 Nov;70(5):950-3
7947103
Cancer Causes Control. 2007 Jun;18(5):493-503
17450441
J Natl Cancer Inst. 1997 May 7;89(9):660-1
9150194
Arch Intern Med. 2000 Nov 27;160(21):3252-7
11088086
JAMA. 2007 Dec 12;298(22):2654-64
18073361
J Natl Cancer Inst. 2006 Jan 18;98(2):135-8
16418516
J Surg Res. 1996 Jun;63(1):310-3
8661216
Cancer Causes Control. 2004 Nov;15(9):873-81
15577289
J Natl Cancer Inst. 2005 Nov 16;97(22):1679-87
16288121
Cancer Epidemiol Biomarkers Prev. 2009 Apr;18(4):1239-42
19336553