title: Time-Dependent Risk of Cancer After a Diabetes Diagnosis in a Cohort of 2.3 Million Adults.
abstract: Using a time-dependent approach, we investigated all-site and site-specific cancer incidence in a large population stratified by diabetes status. The study analyzed a closed cohort comprised of Israelis aged 21-89 years, enrolled in a health fund, and followed from 2002 to 2012. Adjusting for age, ethnicity, and socioeconomic status, we calculated hazard ratios for cancer incidence using Cox regression separately for participants with prevalent and incident diabetes; the latter was further divided by time since diabetes diagnosis. Of the 2,186,196 individuals included in the analysis, 159,104 were classified as having prevalent diabetes, 408,243 as having incident diabetes, and 1,618,849 as free of diabetes. In both men and women, diabetes posed an increased risk of cancers of the liver, pancreas, gallbladder, endometrium, stomach, kidney, brain (benign), brain (malignant), colon/rectum, lung (all, adenocarcinoma, and squamous cell carcinoma), ovary, and bladder, as well as leukemia, multiple myeloma, non-Hodgkin lymphoma, and breast cancer in postmenopausal women. No excess risk was observed for breast cancer in premenopausal women or for thyroid cancer. Diabetes was associated with a reduced risk of prostate cancer. Hazard ratios for all-site and site-specific cancers were particularly elevated during the first year following diabetes diagnosis. The findings of this large study with a time-dependent approach are consistent with those of previous studies that have observed associations between diabetes and cancer incidence.
authors.forename: Rachel
authors.initials: R
authors.lastname: Dankner
authors.forename: Paolo
authors.initials: P
authors.lastname: Boffetta
authors.forename: Ran D
authors.initials: RD
authors.lastname: Balicer
authors.forename: Lital Keinan
authors.initials: LK
authors.lastname: Boker
authors.forename: Maya
authors.initials: M
authors.lastname: Sadeh
authors.forename: Alla
authors.initials: A
authors.lastname: Berlin
authors.forename: Liraz
authors.initials: L
authors.lastname: Olmer
authors.forename: Margalit
authors.initials: M
authors.lastname: Goldfracht
authors.forename: Laurence S
authors.initials: LS
authors.lastname: Freedman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003920:Diabetes Mellitus / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007557:Israel / Q000453:epidemiology; D008297:Male; D008593:Menopause; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D015995:Prevalence; D016016:Proportional Hazards Models; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors; D013997:Time Factors; D055815:Young Adult
keywords: bias (epidemiology); cancer; causality; diabetes mellitus; incidence; population; type 2 diabetes mellitus