TY - JOUR
T1 - Incidence and predictors of all-cause and site-specific cancer in type 2 diabetes: the Fremantle diabetes study
AU - Magliano, Dianna J
AU - Davis, Wendy A
AU - Shaw, Jonathan E
AU - Bruce, David G
AU - Davis, Timothy M E
PY - 2012/10
Y1 - 2012/10
N2 - Objective: To explore the relationship between diabetes and cancer.
Design: The Fremantle Diabetes Study (FDS) was a community-based longitudinal observational study
of 1426 subjects, 1294 of which had type 2 diabetes.
Methods: The FDS type 2 cohort and four age-, sex- and postcode-matched controls per case were followed
for cancer events from1993 until mid-2010 and incidence rate ratios (IRRs) were calculated. Competing
risks proportional hazards models generated risk factors for incident cancers in the diabetic group.
Results: There were 309 first cancers over 13 051 patient-years, or 2368 (95 confidence interval
(95 CI) 2111?2647)/100 000 patient-years in the diabetes patients vs 1131 over 60 324 patient-years
(1875 (1769?1987)/100 000 patient-years) in the controls. For those aged R45 years, the risk of
all-cause cancer was elevated in type 2 diabetic men (IRRs 1.23, 95 CI 1.04?1.45) and women (1.30,
1.06?1.59). The incidence of colorectal cancer was increased (1.36, 1.01?1.82), especially in diabetic
men aged 75?84 years (2.14, 1.22?3.64). Age at diabetes diagnosis (sub-hazard ratio 1.05, 1.02?1.09),
calcium channel blocker therapy (2.37, 1.39?4.06), recent exercise (2.11, 1.06?4.20) and serum total
cholesterol (0.68, 0.52?0.88) increased colorectal cancer risk. Pancreatic cancer was also more frequent
in the diabetic patients (IRR 2.26, 1.20?4.10). Diabeticmen and women had similar risks of prostate and
breast cancer to those of controls (0.83, 0.59?1.14 and 0.86, 0.52?1.36).
Conclusions: Type 2 diabetes is associated with a moderately increased cancer risk in well-characterised
community-based patients, especially pancreatic cancer and colorectal cancer in older men.
Recommended cancer screening should be considered as part of routine diabetes management.
AB - Objective: To explore the relationship between diabetes and cancer.
Design: The Fremantle Diabetes Study (FDS) was a community-based longitudinal observational study
of 1426 subjects, 1294 of which had type 2 diabetes.
Methods: The FDS type 2 cohort and four age-, sex- and postcode-matched controls per case were followed
for cancer events from1993 until mid-2010 and incidence rate ratios (IRRs) were calculated. Competing
risks proportional hazards models generated risk factors for incident cancers in the diabetic group.
Results: There were 309 first cancers over 13 051 patient-years, or 2368 (95 confidence interval
(95 CI) 2111?2647)/100 000 patient-years in the diabetes patients vs 1131 over 60 324 patient-years
(1875 (1769?1987)/100 000 patient-years) in the controls. For those aged R45 years, the risk of
all-cause cancer was elevated in type 2 diabetic men (IRRs 1.23, 95 CI 1.04?1.45) and women (1.30,
1.06?1.59). The incidence of colorectal cancer was increased (1.36, 1.01?1.82), especially in diabetic
men aged 75?84 years (2.14, 1.22?3.64). Age at diabetes diagnosis (sub-hazard ratio 1.05, 1.02?1.09),
calcium channel blocker therapy (2.37, 1.39?4.06), recent exercise (2.11, 1.06?4.20) and serum total
cholesterol (0.68, 0.52?0.88) increased colorectal cancer risk. Pancreatic cancer was also more frequent
in the diabetic patients (IRR 2.26, 1.20?4.10). Diabeticmen and women had similar risks of prostate and
breast cancer to those of controls (0.83, 0.59?1.14 and 0.86, 0.52?1.36).
Conclusions: Type 2 diabetes is associated with a moderately increased cancer risk in well-characterised
community-based patients, especially pancreatic cancer and colorectal cancer in older men.
Recommended cancer screening should be considered as part of routine diabetes management.
UR - http://eje-online.org/content/167/4/589.full.pdf
U2 - 10.1530/EJE-12-0053
DO - 10.1530/EJE-12-0053
M3 - Article
VL - 167
SP - 589
EP - 599
JO - European Journal of Endocrinology
JF - European Journal of Endocrinology
SN - 0804-4643
IS - 4
ER -