Cancer risk among people with type 1 and type 2 diabetes: disentangling true associations, detection bias, and reverse causation

Jessica Lee Harding, Jonathan Edward Shaw, Anna Peeters, Bendix Carstensen, Dianna Josephine Magliano

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Abstract

OBJECTIVE: Evidence indicates an increased risk of certain cancers among people with type 2 diabetes. Evidence for rarer cancers and for type 1 diabetes is limited. We explored the excess risk of site-specific cancer incidence and mortality among people with type 1 and type 2 diabetes, compared with the general Australian population. RESEARCH DESIGN AND METHODS: Registrants of a national diabetes registry (953,382) between 1997 and 2008 were linked to national death and cancer registries. Standardized incidence and mortality ratios (SIRs/SMRs) are reported. RESULTS: For type 1 diabetes, significant elevated SIRs were observed for pancreas, liver, esophagus, colon and rectum(females only [F]), stomach (F), thyroid (F), brain (F), lung (F), endometrium, and ovary, and decreased SIRs were observed for prostate in males. Significantly increased SMRs were observed for pancreas, liver, and kidney (males only), non-Hodgkin s lymphoma, brain (F), and endometrium. For type 2 diabetes, significant SIRs were observed for almost all site-specific cancers, with highest SIRs observed for liver and pancreas, and decreased risks for prostate and melanoma. Significant SMRs were observed for liver, pancreas, kidney, Hodgkin s lymphoma, gallbladder (F), stomach (F), and non-Hodgkin s lymphoma (F). Cancer risk was significantly elevated throughout follow-up time butwas higher in the first 3 months postregistration, suggesting the presence of detection bias and/or reverse causation. CONCLUSIONS: Type 1 and type 2 diabetes are associated with an excess risk of incidence and mortality for overall and a number of site-specific cancers, and this is only partially explained by bias. We suggest that screening for cancers in diabetic patients is important.
Original languageEnglish
Pages (from-to)264 - 270
Number of pages7
JournalDiabetes Care
Volume38
Issue number2
DOIs
Publication statusPublished - 2015

Cite this

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title = "Cancer risk among people with type 1 and type 2 diabetes: disentangling true associations, detection bias, and reverse causation",
abstract = "OBJECTIVE: Evidence indicates an increased risk of certain cancers among people with type 2 diabetes. Evidence for rarer cancers and for type 1 diabetes is limited. We explored the excess risk of site-specific cancer incidence and mortality among people with type 1 and type 2 diabetes, compared with the general Australian population. RESEARCH DESIGN AND METHODS: Registrants of a national diabetes registry (953,382) between 1997 and 2008 were linked to national death and cancer registries. Standardized incidence and mortality ratios (SIRs/SMRs) are reported. RESULTS: For type 1 diabetes, significant elevated SIRs were observed for pancreas, liver, esophagus, colon and rectum(females only [F]), stomach (F), thyroid (F), brain (F), lung (F), endometrium, and ovary, and decreased SIRs were observed for prostate in males. Significantly increased SMRs were observed for pancreas, liver, and kidney (males only), non-Hodgkin s lymphoma, brain (F), and endometrium. For type 2 diabetes, significant SIRs were observed for almost all site-specific cancers, with highest SIRs observed for liver and pancreas, and decreased risks for prostate and melanoma. Significant SMRs were observed for liver, pancreas, kidney, Hodgkin s lymphoma, gallbladder (F), stomach (F), and non-Hodgkin s lymphoma (F). Cancer risk was significantly elevated throughout follow-up time butwas higher in the first 3 months postregistration, suggesting the presence of detection bias and/or reverse causation. CONCLUSIONS: Type 1 and type 2 diabetes are associated with an excess risk of incidence and mortality for overall and a number of site-specific cancers, and this is only partially explained by bias. We suggest that screening for cancers in diabetic patients is important.",
author = "Harding, {Jessica Lee} and Shaw, {Jonathan Edward} and Anna Peeters and Bendix Carstensen and Magliano, {Dianna Josephine}",
year = "2015",
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Cancer risk among people with type 1 and type 2 diabetes: disentangling true associations, detection bias, and reverse causation. / Harding, Jessica Lee; Shaw, Jonathan Edward; Peeters, Anna; Carstensen, Bendix; Magliano, Dianna Josephine.

In: Diabetes Care, Vol. 38, No. 2, 2015, p. 264 - 270.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Cancer risk among people with type 1 and type 2 diabetes: disentangling true associations, detection bias, and reverse causation

AU - Harding, Jessica Lee

AU - Shaw, Jonathan Edward

AU - Peeters, Anna

AU - Carstensen, Bendix

AU - Magliano, Dianna Josephine

PY - 2015

Y1 - 2015

N2 - OBJECTIVE: Evidence indicates an increased risk of certain cancers among people with type 2 diabetes. Evidence for rarer cancers and for type 1 diabetes is limited. We explored the excess risk of site-specific cancer incidence and mortality among people with type 1 and type 2 diabetes, compared with the general Australian population. RESEARCH DESIGN AND METHODS: Registrants of a national diabetes registry (953,382) between 1997 and 2008 were linked to national death and cancer registries. Standardized incidence and mortality ratios (SIRs/SMRs) are reported. RESULTS: For type 1 diabetes, significant elevated SIRs were observed for pancreas, liver, esophagus, colon and rectum(females only [F]), stomach (F), thyroid (F), brain (F), lung (F), endometrium, and ovary, and decreased SIRs were observed for prostate in males. Significantly increased SMRs were observed for pancreas, liver, and kidney (males only), non-Hodgkin s lymphoma, brain (F), and endometrium. For type 2 diabetes, significant SIRs were observed for almost all site-specific cancers, with highest SIRs observed for liver and pancreas, and decreased risks for prostate and melanoma. Significant SMRs were observed for liver, pancreas, kidney, Hodgkin s lymphoma, gallbladder (F), stomach (F), and non-Hodgkin s lymphoma (F). Cancer risk was significantly elevated throughout follow-up time butwas higher in the first 3 months postregistration, suggesting the presence of detection bias and/or reverse causation. CONCLUSIONS: Type 1 and type 2 diabetes are associated with an excess risk of incidence and mortality for overall and a number of site-specific cancers, and this is only partially explained by bias. We suggest that screening for cancers in diabetic patients is important.

AB - OBJECTIVE: Evidence indicates an increased risk of certain cancers among people with type 2 diabetes. Evidence for rarer cancers and for type 1 diabetes is limited. We explored the excess risk of site-specific cancer incidence and mortality among people with type 1 and type 2 diabetes, compared with the general Australian population. RESEARCH DESIGN AND METHODS: Registrants of a national diabetes registry (953,382) between 1997 and 2008 were linked to national death and cancer registries. Standardized incidence and mortality ratios (SIRs/SMRs) are reported. RESULTS: For type 1 diabetes, significant elevated SIRs were observed for pancreas, liver, esophagus, colon and rectum(females only [F]), stomach (F), thyroid (F), brain (F), lung (F), endometrium, and ovary, and decreased SIRs were observed for prostate in males. Significantly increased SMRs were observed for pancreas, liver, and kidney (males only), non-Hodgkin s lymphoma, brain (F), and endometrium. For type 2 diabetes, significant SIRs were observed for almost all site-specific cancers, with highest SIRs observed for liver and pancreas, and decreased risks for prostate and melanoma. Significant SMRs were observed for liver, pancreas, kidney, Hodgkin s lymphoma, gallbladder (F), stomach (F), and non-Hodgkin s lymphoma (F). Cancer risk was significantly elevated throughout follow-up time butwas higher in the first 3 months postregistration, suggesting the presence of detection bias and/or reverse causation. CONCLUSIONS: Type 1 and type 2 diabetes are associated with an excess risk of incidence and mortality for overall and a number of site-specific cancers, and this is only partially explained by bias. We suggest that screening for cancers in diabetic patients is important.

UR - http://care.diabetesjournals.org/content/38/2/264

U2 - 10.2337/dc14-1996

DO - 10.2337/dc14-1996

M3 - Article

VL - 38

SP - 264

EP - 270

JO - Diabetes Care

JF - Diabetes Care

SN - 0149-5992

IS - 2

ER -