title: Venous thromboembolism and risk of cancer in patients with diabetes mellitus.
abstract: OBJECTIVE
  Venous thromboembolism (VTE) has long been regarded as a marker of underlying malignancy in the general population. Patients with diabetes mellitus are at increased risk of developing VTE, but it is unclear whether VTE in diabetes patients is also a harbinger of occult cancer.
  
  
  METHODS
  From Danish medical health databases, we identified all diabetes patients (N=8783) with a first-time diagnosis of VTE during 1978-2011. We followed the patients until a first-time diagnosis of cancer, emigration, death, or study end, whichever came first. We calculated one-year absolute cancer risk and overall and site-specific standardized incidence ratios (SIRs) for cancer based on national cancer incidence.
  
  
  RESULTS
  During the total study period 878 cancers were observed. The one-year absolute cancer risk was 4.1% and the corresponding SIR was 3.28 (95% confidence interval [CI]: 2.94-3.64). The highest SIRs were observed for cancers of the gallbladder and biliary tract (SIR 13.59; 6.77-24.31), the pancreas (SIR 10.16; 6.85-14.50), the ovary (SIR 9.85; 5.63-16.00), and the liver (SIR 9.39; 4.30-17.84). After the first year of follow-up, the overall cancer SIR associated with VTE and diabetes decreased to 1.05 (95% CI: 0.97-1.15).
  
  
  CONCLUSIONS
  VTE may be a marker of underlying cancer in patients with diabetes mellitus.
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark; Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Norrebrogade 44, 8000 Aarhus C, Denmark. Electronic address: dhcr@clin.au.dk.
authors.forename: Diana Hedevang
authors.initials: DH
authors.lastname: Christensen
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark.
authors.forename: Erzsébet
authors.initials: E
authors.lastname: Horváth-Puhó
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark.
authors.forename: Reimar Wernich
authors.initials: RW
authors.lastname: Thomsen
authors.affiliation: Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Norrebrogade 44, 8000 Aarhus C, Denmark.
authors.forename: Søren Tang
authors.initials: ST
authors.lastname: Knudsen
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark; Department of Clinical Epidemiology and Metabolism, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, The Netherlands.
authors.forename: Olaf
authors.initials: O
authors.lastname: Dekkers
authors.affiliation: Department of Cardiothoracic and Vascular Science, Thromboembolism Unit, University of Padua, Via Giustiniani 2, 35128 Padua, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Prandoni
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark.
authors.forename: Henrik Toft
authors.initials: HT
authors.lastname: Sørensen
mesh_terms: D000368:Aged; D015415:Biomarkers; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003925:Diabetic Angiopathies / Q000150:complications*; D004067:Digestive System Neoplasms / Q000150:complications* / Q000453:epidemiology; D004701:Endocrine Gland Neoplasms / Q000150:complications* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000453:epidemiology; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000150:complications*
chemical_list: D015415:Biomarkers
keywords: Cancer; Deep venous thrombosis; Diabetes mellitus; Epidemiology; Pulmonary embolism; Venous thromboembolism