Association between type 2 diabetes and risk of cancer mortality: a pooled analysis of over 771,000 individuals in the Asia Cohort Consortium

Abstract

Aims/hypothesis The aims of the study were to evaluate the association between type 2 diabetes and the risk of death from any cancer and specific cancers in East and South Asians. Methods Pooled analyses were conducted of 19 prospective population-based cohorts included in the Asia Cohort Consortium, comprising data from 658,611 East Asians and 112,686 South Asians. HRs were used to compare individuals with diabetes at baseline with those without diabetes for the risk of death from any cancer and from site-specific cancers, including cancers of the oesophagus, stomach, colorectum, colon, rectum, liver, bile duct, pancreas, lung, breast, endometrium, cervix, ovary, prostate, bladder, kidney and thyroid, as well as lymphoma and leukaemia. Results During a mean follow-up of 12.7 years, 37,343 cancer deaths (36,667 in East Asians and 676 in South Asians) were identified. Baseline diabetes status was statistically significantly associated with an increased risk of death from any cancer (HR 1.26;95% CI1.21, 1.31). Significant positive associations with diabetes were observed for cancers of the colorectum(HR 1.41;95% CI 1.26, 1.57), liver (HR 2.05;95% CI 1.77, 2.38), bile duct (HR 1.41;95% CI 1.04, 1.92), gallbladder (HR 1.33; 95% CI1.10, 1.61), pancreas (HR 1.53; 95% CI1.32, 1.77), breast (HR 1.72; 95% CI1.34, 2.19), endometrium (HR 2.73; 95% CI1.53, 4.85), ovary (HR 1.60; 95% CI1.06, 2.42), prostate (HR 1.41; 95% CI1.09, 1.82), kidney (HR 1.84; 95% CI1.28, 2.64) and thyroid (HR 1.99; 95% CI1.03, 3.86), as well as lymphoma (HR 1.39; 95% CI1.04, 1.86). Diabetes was not statistically significantly associated with the risk of death from leukaemia and cancers of the bladder, cervix, oesophagus, stomach and lung. Conclusions/interpretation Diabetes was associated with a 26% increased risk of death from any cancer in Asians. The pattern of associations with specific cancers suggests the need for better control (prevention, detection, management) of the growing epidemic of diabetes (as well as obesity), in order to reduce cancer mortality.

Hyperglycemia, Classified with Multiple Biomarkers Simultaneously in Men without Diabetes, and Risk of Fatal Prostate Cancer

“…In all of our models, diagnosed diabetes had a nonsignificant, positive association with lethal prostate cancer and prostate cancer mortality compared with men without diabetes with normal glycemia values based on one or more biomarker. Our findings for prostate cancer mortality are consistent with a pooled analysis of Asian cohorts that reported a significant, positive association between selfreported diabetes (versus no) and prostate cancer mortality (9). In contrast, in the Cancer Prevention Study-II, selfreported diabetes (versus no) was associated with a lower risk of prostate cancer mortality (13).…”

“…There have been fewer studies of diabetes and prostate cancer mortality, and findings have been inconsistent. Some studies have reported a positive association between diabetes and prostate cancer mortality (9,10), whereas others have reported a possible inverse association (11)(12)(13). As the U.S. diabetes prevalence has substantially increased in recent years (14), a better understanding of the relationship between the diabetes, underlying glycemia, and prostate cancer carcinogenesis is needed.…”

Metabolic disorders across hepatocellular carcinoma in Italy

“…Our result supports and extends to Western HCC patients-managed in an updated way-the findings of quite old studies usually based on small surgical cohorts of Asiatic patients, reporting an adverse impact of diabetes on the outcome of patients with cirrhosis and HCC. [36][37][38][39][40] Nevertheless, despite these evidences and the well-known pathogenic role of diabetes on cardiac, renal and neurological diseases, other studies report a better prognosis of patients with HCC and diabetes as compared to non-diabetic patients. 8,41 This surprising and difficult to understand discrepancy probably relies on the effect of selection biases and confounding factors on results.…”

Metabolic conditions and breast cancer risk among Los Angeles County Filipina Americans compared with Chinese and Japanese Americans

“…Diabetes was unrelated to breast cancer risk in a pooled analysis of cohort studies from Japan and among Japanese Americans in the Multiethnic Cohort study . However, diabetes was significantly associated with breast cancer mortality in a prospective cohort study from Korea and in a recent Asia Cohort Consortium pooled analysis in which BMI was considered . Hyperinsulinemia, impaired secretion of adipokines and chronic inflammation have been implicated to link diabetes to breast cancer risk …”

“…35 However, diabetes was significantly associated with breast cancer mortality in a prospective cohort study from Korea 36 and in a recent Asia Cohort Consortium pooled analysis in which BMI was considered. 37 Hyperinsulinemia, impaired secretion of adipokines and chronic inflammation have been implicated to link diabetes to breast cancer risk. 38 Breast cancer risk in Asian Americans was significantly associated with history of hypertension among Filipina women, particularly among those who had HBP within the 10 years before diagnosis of breast cancer/interview.…”