title: Adult life after childhood cancer in Scandinavia: diabetes mellitus following treatment for cancer in childhood.
abstract: OBJECTIVE
  An increased risk for diabetes mellitus (DM) adds significantly to the burden of late complications in childhood cancer survivors. Complications of DM may be prevented by using appropriate screening. It is, therefore, important to better characterise the reported increased risk for DM in a large population-based setting.
  
  
  METHODS
  From the national cancer registries of the five Nordic countries, a cohort of 32,903 1-year survivors of cancer diagnosed before the age of 20 between start of cancer registration in the 1940s and 1950s through 2008 was identified; 212,393 comparison subjects of the same age, gender and country were selected from national population registers. Study subjects were linked to the national hospital registers. Absolute excess risks (AERs) and standardised hospitalisation rate ratios (SHRRs) were calculated.
  
  
  RESULTS
  DM was diagnosed in 496 childhood cancer survivors, yielding an overall SHRR of 1.6 (95% confidence interval (CI), 1.5-1.8) and an AER of 43 per 100,000 person-years, increasing from approximately 20 extra cases of DM in ages 0-19 to more than 100 extra cases per 100,000 person-years in ages > or =50. The relative risks for DM were significantly increased after Wilms' tumour (SHRR, 2.9), leukaemia (2.0), CNS neoplasms (1.8), germ-cell neoplasms (1.7), malignant bone tumours (1.7) and Hodgkin's lymphoma (1.6). The risk for DM type 2 was slightly higher than that for type 1.
  
  
  CONCLUSIONS
  Childhood cancer survivors are at increased risk for DM, with absolute risks increasing throughout life. These findings underscore the need for preventive interventions and prolonged follow-up of childhood cancer survivors.
authors: Paediatric Oncology and Haematology, Skåne University Hospital, Department of Clinical Sciences, Lund University, Lund, Sweden. Electronic address: anna.sallfors-holmqvist@med.lu.se.
authors: Anna Sällfors
authors: AS
authors: Holmqvist
authors: Danish Cancer Society Research Centre, Danish Cancer Society, Copenhagen, Denmark.
authors: Jørgen H
authors: JH
authors: Olsen
authors: Danish Cancer Society Research Centre, Danish Cancer Society, Copenhagen, Denmark.
authors: Klaus Kaae
authors: KK
authors: Andersen
authors: Danish Cancer Society Research Centre, Danish Cancer Society, Copenhagen, Denmark.
authors: Sofie
authors: S
authors: de Fine Licht
authors: Paediatric Oncology and Haematology, Skåne University Hospital, Department of Clinical Sciences, Lund University, Lund, Sweden.
authors: Lars
authors: L
authors: Hjorth
authors: Paediatric Oncology and Haematology, Skåne University Hospital, Department of Clinical Sciences, Lund University, Lund, Sweden.
authors: Stanislaw
authors: S
authors: Garwicz
authors: Paediatric Oncology and Haematology, Skåne University Hospital, Department of Clinical Sciences, Lund University, Lund, Sweden.
authors: Christian
authors: C
authors: Moëll
authors: Department of Cancer Epidemiology, Lund University, Lund, Sweden.
authors: Harald
authors: H
authors: Anderson
authors: Cancer Registry of Norway, Department of Paediatric Medicine, Oslo University Hospital, Faculty of Medicine, University of Oslo, Oslo, Norway.
authors: Finn
authors: F
authors: Wesenberg
authors: Icelandic Cancer Registry, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
authors: Laufey
authors: L
authors: Tryggvadottir
authors: Finnish Cancer Registry, Helsinki, Finland.
authors: Nea
authors: N
authors: Malila
authors: Vanderbilt University, Department of Medicine, Vanderbilt-Ingram Cancer Centre, Nashville, TN, USA; National Council on Radiation Protection and Measurements, Bethesda, MD, USA.
authors: John D
authors: JD
authors: Boice
authors: Department of Paediatrics, Aarhus University Hospital, Aarhus, Denmark.
authors: Henrik
authors: H
authors: Hasle
authors: Danish Cancer Society Research Centre, Danish Cancer Society, Copenhagen, Denmark.
authors: Jeanette Falck
authors: JF
authors: Winther
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015897:Comorbidity; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000145:classification / Q000453:epidemiology* / Q000628:therapy; D016016:Proportional Hazards Models; D012042:Registries / Q000706:statistics & numerical data; D018570:Risk Assessment / Q000706:statistics & numerical data; D012307:Risk Factors; D012537:Scandinavian and Nordic Countries / Q000453:epidemiology; D017741:Survivors / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Complications; Diabetes mellitus; Neoplasms; Survivors