title: Effect of elevated basal insulin on cancer incidence and mortality in cancer incident patients: the Israel GOH 29-year follow-up study.
abstract: OBJECTIVE
  Diabetes is associated with many forms of cancer. Recent evidence has suggested that some treatments for diabetes are associated with an increased cancer risk. Less is known about the association between endogenous insulin in the prediabetes state and cancer risk.
  
  
  METHODS
  We investigated cumulative cancer incidence and cancer incidence density over 29 years, according to basal insulin, in a cohort of 1,695 nondiabetic men and women of four ethnic origins, aged 51.8 ± 8.0 years at baseline. Total mortality among the 317 subjects (18.7%) who developed cancer at least 2 years after baseline was assessed.
  
  
  RESULTS
  In a Cox proportional hazards model, the all-site hazard ratio of cancer incidence comparing the highest insulin quartile with the other three quartiles was 1.09 (95% CI 0.85-1.40), adjusted for age, sex, and ethnicity. BMI, smoking, and fasting blood glucose were not statistically significant in this model. Basal insulin level was not significantly associated with cancer of specific sites (breast, prostate, colon/rectum, or bladder). Fasting insulin in the upper quartile conferred a 37% increased risk for total mortality among cancer patients, adjusting for age, sex, and ethnic origin (95% CI 0.94-2.00, P = 0.097) compared with that of the lower quartiles. Male sex, older age, and North African origins were associated with a greater risk of mortality during follow-up time.
  
  
  CONCLUSIONS
  This long-term cohort study may suggest a role for basal elevated insulin levels, mainly as a negative predictor in cancer prognosis.
authors.affiliation: Unit of Cardiovascular Epidemiology, The Gertner Institute for Epidemiology and Health Policy Research, Ramat Gan, Israel. rdankner@gertner.health.gov.il
authors.forename: Rachel
authors.initials: R
authors.lastname: Dankner
authors.forename: Michael H
authors.initials: MH
authors.lastname: Shanik
authors.forename: Lital
authors.initials: L
authors.lastname: Keinan-Boker
authors.forename: Cindy
authors.initials: C
authors.lastname: Cohen
authors.forename: Angela
authors.initials: A
authors.lastname: Chetrit
mesh_terms: D000328:Adult; D044383:Black People; D005006:Ethnicity; D005260:Female; D006801:Humans; D006946:Hyperinsulinism / Q000150:complications / Q000453:epidemiology*; D015994:Incidence; D007328:Insulin / Q000097:blood; D007557:Israel / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality
chemical_list: D007328:Insulin