title: Risk of cancer in a large cohort of U.S. veterans with diabetes.
abstract: 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.
authors.affiliation: Division of Cancer Epidemiology and Genetics, NCI, NIH, DHHS, Bethesda, MD, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Atchison
authors.forename: Gloria
authors.initials: G
authors.lastname: Gridley
authors.forename: J Daniel
authors.initials: JD
authors.lastname: Carreon
authors.forename: Michael F
authors.initials: MF
authors.lastname: Leitzmann
authors.forename: Katherine A
authors.initials: KA
authors.lastname: McGlynn
mesh_terms: 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
chemical_list: D013739:Testosterone
references.citation: Cancer Causes Control. 2008 Sep;19(7):703-10
references.pmid: 18340542
references.citation: Lancet. 1970 Jan 31;1(7640):218-20
references.pmid: 4189012
references.citation: Int J Cancer. 2006 May 1;118(9):2293-7
references.pmid: 16331628
references.citation: Am J Epidemiol. 2004 Jun 15;159(12):1160-7
references.pmid: 15191933
references.citation: J Clin Epidemiol. 2001 Aug;54(8):802-9
references.pmid: 11470389
references.citation: J Natl Cancer Inst. 2000 Jul 5;92(13):1096-9
references.pmid: 10880555
references.citation: Int J Cancer. 1990 May 15;45(5):816-20
references.pmid: 2335385
references.citation: World J Gastroenterol. 2008 Oct 7;14(37):5695-700
references.pmid: 18837086
references.citation: Diabetologia. 1999 Jan;42(1):107-12
references.pmid: 10027588
references.citation: J Natl Cancer Inst. 1970 Mar;44(3):673-86
references.pmid: 11515436
references.citation: Cancer Epidemiol Biomarkers Prev. 2009 May;18(5):1350-6
references.pmid: 19383895
references.citation: Am J Epidemiol. 1990 Feb;131(2):254-62
references.pmid: 2296978
references.citation: J Natl Cancer Inst. 2003 Dec 3;95(23):1797-800
references.pmid: 14652242
references.citation: Ann Oncol. 2006 Sep;17(9):1459-63
references.pmid: 16873426
references.citation: Diabetes Care. 2006 Aug;29(8):1990-1
references.pmid: 16873829
references.citation: Cancer Res. 2002 Feb 15;62(4):1030-5
references.pmid: 11861378
references.citation: Hepatology. 2006 Dec;44(6):1408-10
references.pmid: 17133479
references.citation: Br J Prev Soc Med. 1976 Sep;30(3):151-7
references.pmid: 974434
references.citation: J Clin Endocrinol Metab. 2006 Jul;91(7):2562-8
references.pmid: 16608892
references.citation: Pancreatology. 2007;7(2-3):187-93
references.pmid: 17592233
references.citation: Diabetologia. 2004 Jun;47(6):1071-8
references.pmid: 15164171
references.citation: J Natl Cancer Inst. 1996 Oct 16;88(20):1472-7
references.pmid: 8841022
references.citation: Cancer Epidemiol Biomarkers Prev. 1995 Dec;4(8):807-11
references.pmid: 8634649
references.citation: Cancer Causes Control. 1991 Sep;2(5):307-14
references.pmid: 1932543
references.citation: JAMA. 1995 May 24-31;273(20):1605-9
references.pmid: 7745774
references.citation: Cancer Res. 1997 Nov 1;57(21):4787-94
references.pmid: 9354440
references.citation: Diabetes Care. 2004 Jan;27 Suppl 1:S74-5
references.pmid: 14693932
references.citation: J Natl Cancer Inst. 1997 Sep 17;89(18):1360-5
references.pmid: 9308706
references.citation: Int J Cancer. 2002 Nov 20;102(3):258-61
references.pmid: 12397646
references.citation: Am J Epidemiol. 2009 Apr 15;169(8):937-45
references.pmid: 19240222
references.citation: Cancer Causes Control. 1998 Jan;9(1):3-9
references.pmid: 9486458
references.citation: Br J Cancer. 2005 Jun 6;92(11):2076-83
references.pmid: 15886696
references.citation: J Chronic Dis. 1971 Jan;23(8):579-600
references.pmid: 4933059
references.citation: Arch Intern Med. 2006 Sep 25;166(17):1871-7
references.pmid: 17000944
references.citation: J Chronic Dis. 1982;35(1):13-9
references.pmid: 7068798
references.citation: Br J Cancer. 2009 Oct 6;101(7):1199-201
references.pmid: 19690547
references.citation: Hepatology. 2006 Jun;43(6):1295-302
references.pmid: 16729295
references.citation: Cancer Epidemiol Biomarkers Prev. 2006 Nov;15(11):2056-62
references.pmid: 17119028
references.citation: Cancer Epidemiol Biomarkers Prev. 2009 Jul;18(7):2079-89
references.pmid: 19567501
references.citation: J Nutr. 2001 Nov;131(11 Suppl):3109S-20S
references.pmid: 11694656
references.citation: J Natl Cancer Inst. 1995 Jun 21;87(12):930-1
references.pmid: 7666483
references.citation: Lancet. 2004 Apr 24;363(9418):1346-53
references.pmid: 15110491
references.citation: Am J Epidemiol. 1992 Nov 1;136(9):1110-4
references.pmid: 1462971
references.citation: J Epidemiol Community Health. 2002 Jun;56(6):479-80; author reply 480
references.pmid: 12011210
references.citation: Diabetes Care. 2001 Nov;24(11):1936-40
references.pmid: 11679460
references.citation: Am J Epidemiol. 2008 Jul 15;168(2):158-69
references.pmid: 18483121
references.citation: Cancer Epidemiol Biomarkers Prev. 2006 Aug;15(8):1458-63
references.pmid: 16896032
references.citation: J Natl Cancer Inst. 2002 Jul 3;94(13):972-80
references.pmid: 12096082
references.citation: Diabetes Care. 1998 Jul;21(7):1138-45
references.pmid: 9653609
references.citation: Cancer Invest. 2002;20(2):157-65
references.pmid: 11901534
references.citation: J Chronic Dis. 1985;38(5):435-41
references.pmid: 3998058
references.citation: Am J Epidemiol. 2003 Jun 15;157(12):1092-100
references.pmid: 12796045
references.citation: Cancer Res. 1990 Jan 1;50(1):103-7
references.pmid: 2152769
references.citation: J Natl Cancer Inst. 1991 Dec 18;83(24):1820-6
references.pmid: 1660542
references.citation: Br J Cancer. 2001 Feb 2;84(3):417-22
references.pmid: 11161410
references.citation: Int J Cancer. 2006 Apr 15;118(8):2105-9
references.pmid: 16284945
references.citation: Br J Cancer. 1994 Nov;70(5):950-3
references.pmid: 7947103
references.citation: Cancer Causes Control. 2007 Jun;18(5):493-503
references.pmid: 17450441
references.citation: J Natl Cancer Inst. 1997 May 7;89(9):660-1
references.pmid: 9150194
references.citation: Arch Intern Med. 2000 Nov 27;160(21):3252-7
references.pmid: 11088086
references.citation: JAMA. 2007 Dec 12;298(22):2654-64
references.pmid: 18073361
references.citation: J Natl Cancer Inst. 2006 Jan 18;98(2):135-8
references.pmid: 16418516
references.citation: J Surg Res. 1996 Jun;63(1):310-3
references.pmid: 8661216
references.citation: Cancer Causes Control. 2004 Nov;15(9):873-81
references.pmid: 15577289
references.citation: J Natl Cancer Inst. 2005 Nov 16;97(22):1679-87
references.pmid: 16288121
references.citation: Cancer Epidemiol Biomarkers Prev. 2009 Apr;18(4):1239-42
references.pmid: 19336553