title: Prospective study reveals associations between colorectal cancer and type 2 diabetes mellitus or insulin use in men.
abstract: OBJECTIVE
  Type 2 diabetes mellitus (DM) is associated with an increased risk of colorectal cancer (CRC); it is not clear if this association varies by sex or other factors. Insulin use might also be associated with CRC risk. We investigated associations of type 2 DM and insulin use with CRC risk.
  
  
  METHODS
  The Cancer Prevention Study II Nutrition Cohort is a prospective study of cancer incidence. In 1992 or 1993, adult participants (n = 184,194) completed a detailed, self-administered questionnaire. Follow-up questionnaires were sent in 1997 and every 2 years thereafter. Cox proportional hazards regression analysis was used to calculate relative risks (RR) and 95% confidence intervals (CI), adjusting for covariates.
  
  
  RESULTS
  After exclusions, 73,312 men and 81,663 women remained in the final analytic cohort; 1567 men (227 with type 2 DM) and 1242 women (108 with type 2 DM) were diagnosed with colon or rectal cancer by 2007. Among men, type 2 DM was associated with increased risk of incident CRC compared to not having type 2 DM (RR: 1.24; 95% CI: 1.08-1.44); risk was higher for participants with type 2 DM using insulin (RR: 1.36; 95% CI: 1.05-1.78), and participants with type 2 DM not using insulin (RR: 1.22, 95% CI: 1.04-1.45). Among women, type 2 DM and insulin use were not associated with risk of incident CRC (RR: 1.01; 95% CI: 0.82-1.23 and RR: 0.95; 95% CI: 0.64-1.41, respectively).
  
  
  CONCLUSIONS
  There is a modest association between type 2 DM and CRC among men, but not women. Insulin use is not associated with a substantially increased risk of CRC.
authors.affiliation: Epidemiology Research Program, American Cancer Society, National Home Office, Atlanta, Georgia 30303, USA. peter.campbell@cancer.org
authors.forename: Peter T
authors.initials: PT
authors.lastname: Campbell
authors.forename: Anusila
authors.initials: A
authors.lastname: Deka
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Jacobs
authors.forename: Christina C
authors.initials: CC
authors.lastname: Newton
authors.forename: Janet S
authors.initials: JS
authors.lastname: Hildebrand
authors.forename: Marjorie L
authors.initials: ML
authors.lastname: McCullough
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Limburg
authors.forename: Susan M
authors.initials: SM
authors.lastname: Gapstur
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000209:etiology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D006801:Humans; D007328:Insulin / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012306:Risk; D018426:SEER Program; D012727:Sex Characteristics
chemical_list: D007328:Insulin