title: Cancer incidence in persons with type 1 diabetes: a five-country study of 9,000 cancers in type 1 diabetic individuals.
abstract: OBJECTIVE
  An excess cancer incidence of 20-25% has been identified among persons with diabetes, most of whom have type 2 diabetes. We aimed to describe the association between type 1 diabetes and cancer incidence.
  
  
  METHODS
  Persons with type 1 diabetes were identified from five nationwide diabetes registers: Australia (2000-2008), Denmark (1995-2014), Finland (1972-2012), Scotland (1995-2012) and Sweden (1987-2012). Linkage to national cancer registries provided the numbers of incident cancers in people with type 1 diabetes and in the general population. We used Poisson models with adjustment for age and date of follow up to estimate hazard ratios for total and site-specific cancers.
  
  
  RESULTS
  A total of 9,149 cancers occurred among persons with type 1 diabetes in 3.9 million person-years. The median age at cancer diagnosis was 51.1 years (interquartile range 43.5-59.5). The hazard ratios (HRs) (95% CIs) associated with type 1 diabetes for all cancers combined were 1.01 (0.98, 1.04) among men and 1.07 (1.04, 1.10) among women. HRs were increased for cancer of the stomach (men, HR 1.23 [1.04, 1.46]; women, HR 1.78 [1.49, 2.13]), liver (men, HR 2.00 [1.67, 2.40]; women, HR 1.55 [1.14, 2.10]), pancreas (men, HR 1.53 [1.30, 1.79]; women, HR 1.25 [1.02,1.53]), endometrium (HR 1.42 [1.27, 1.58]) and kidney (men, HR 1.30 [1.12, 1.49]; women, HR 1.47 [1.23, 1.77]). Reduced HRs were found for cancer of the prostate (HR 0.56 [0.51, 0.61]) and breast (HR 0.90 [0.85, 0.94]). HRs declined with increasing diabetes duration.
  
  
  CONCLUSIONS
  Type 1 diabetes was associated with differences in the risk of several common cancers; the strength of these associations varied with the duration of diabetes.
authors.affiliation: Steno Diabetes Centre, Gentofte, Denmark.
authors.forename: Bendix
authors.initials: B
authors.lastname: Carstensen
authors.affiliation: Usher Institute of Population Health Sciences & Informatics, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, Scotland, UK. Stephanie.read@ed.ac.uk.
authors.forename: Stephanie H
authors.initials: SH
authors.lastname: Read
authors.affiliation: Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark.
authors.forename: Søren
authors.initials: S
authors.lastname: Friis
authors.affiliation: Centre for Research Methods, Department of Social Research, University of Helsinki, Helsinki, Finland.
authors.forename: Reijo
authors.initials: R
authors.lastname: Sund
authors.affiliation: Division of Health and Social Services, National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Ilmo
authors.initials: I
authors.lastname: Keskimäki
authors.affiliation: Department of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Ann-Marie
authors.initials: AM
authors.lastname: Svensson
authors.affiliation: Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Rickard
authors.initials: R
authors.lastname: Ljung
authors.affiliation: Usher Institute of Population Health Sciences & Informatics, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, Scotland, UK.
authors.forename: Sarah H
authors.initials: SH
authors.lastname: Wild
authors.affiliation: Information Services, NHS National Services Scotland, Edinburgh, Scotland, UK.
authors.forename: Joannes J
authors.initials: JJ
authors.lastname: Kerssens
authors.affiliation: Department of Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Harding
authors.affiliation: Department of Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia.
authors.forename: Dianna J
authors.initials: DJ
authors.lastname: Magliano
authors.affiliation: Department of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Soffia
authors.initials: S
authors.lastname: Gudbjörnsdottir
mesh_terms: D001315:Australia / Q000453:epidemiology; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D009369:Neoplasms / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology; D013548:Sweden / Q000453:epidemiology
keywords: Cancer incidence; Cancer rate ratio; Cancer subtypes; Diabetes duration