Diabetes in relation to biliary tract cancer and stones: a population-based study in Shanghai, China.
BACKGROUND
Biliary tract cancers are rare but fatal malignancies. Diabetes has been related to biliary stones, but its association with biliary tract cancers is less conclusive.


METHODS
In a population-based case-control study of 627 cancers, 1037 stones, and 959 controls in Shanghai, China, we examined the association between diabetes and the risks of biliary tract cancer and stones, as well as the effect of potential mediating factors, including serum lipids and biliary stones (for cancer), contributing to the causal pathway from diabetes to biliary diseases.


RESULTS
Independent of body mass index (BMI), diabetes was significantly associated with gallbladder cancer and biliary stones ((odds ratio (OR) (95% confidence interval)=2.6 (1.5-4.7) and 2.0 (1.2-3.3), respectively). Biliary stones and low serum levels of high-density lipoprotein (HDL) were significant mediators of the diabetes effect on gallbladder cancer risk, accounting for 60 and 17% of the diabetes effect, respectively. High-density lipoprotein was also a significant mediator of the diabetes effect on biliary stones, accounting for 18% of the diabetes effect.


CONCLUSIONS
Independent of BMI, diabetes is a risk factor for gallbladder cancer, but its effect is mediated in part by biliary stones and serum HDL levels, suggesting that gallbladder cancer risk may be reduced by controlling diabetes, stones, and HDL levels.
Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institute of Health, Bethesda, MD, USA. sheblf@mail.nih.gov
F M
FM
Shebl
G
G
Andreotti
A
A
Rashid
Y-T
YT
Gao
K
K
Yu
M-C
MC
Shen
B-S
BS
Wang
Q
Q
Li
T-Q
TQ
Han
B-H
BH
Zhang
J F
JF
Fraumeni
A W
AW
Hsing
D000328:Adult; D000368:Aged; D001661:Biliary Tract Neoplasms / Q000097:blood / Q000209:etiology*; D015992:Body Mass Index; D002681:China; D048909:Diabetes Complications / Q000209:etiology*; D005260:Female; D005706:Gallbladder Neoplasms / Q000097:blood / Q000209:etiology; D042882:Gallstones / Q000150:complications*; D006801:Humans; D008075:Lipoproteins, HDL / Q000097:blood; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
D008075:Lipoproteins, HDL