Cancer and Diabetes

Hsin-Chieh Yeh, Ph.D.

EPIDEMIOLOGY

Diabetes associated with increased risk of non-Hodgkin lymphoma[35] and cancer of breast,[42] colorectum,[49] endometrium,[41] liver[45], and pancreas[50].
Negatively associated with risk of prostate cancer[44].
Hypotheses about possible link between diabetes and cancer include:
- Insulin is known to stimulate cell proliferation[27].
- Hyperglycemia promotes tumor growth[55][36].
- Shared risk factors such as obesity [51], diet, physical inactivity[51], hepatitis C[37], NAFLD[46].

Diabetes associated with:
- Increased risk of death from colon and pancreatic cancer in both men and women;
- Increased risk of death from liver and bladder cancers in men; and
- Increased risk of death from breast cancer in women[54]
Also reported positive associations with death from:
- Esophagus, liver, and colon/rectum cancers in men, and
- Liver and cervix cancers in women[52]

Meta-analyses showed diabetes associated with an increased mortality in patients with any cancer [HR of 1.44], cancers of the endometrium (HR, 1.76), breast (HR, 1.61), colorectum (HR, 1.32), and prostate[28][24].
Meta-analysis showed diabetes associated with increased odds of postoperative mortality across all cancer types [HR=1.5][28].
Hyperglycemia associated with shorter duration of complete remission in patients with acute lymphocytic leukemia[53].
Hyperglycemia associated with shorter survival in patients with newly diagnosed glioblastoma[32].

Negatively associated with risk of prostate cancer[44].
Androgen deprivation therapy causes changes in body composition, alterations in lipid profiles, and decreased insulin sensitivity[25].
Androgen deprivation therapy significantly increased risk for diabetes mellitus[33][1].

Relative risks from meta-analyses or pooled analyses range from 1.2 to 1.5 for overweight and 1.5 to 1.8 for obesity with respect to cancers of the colon[39], gastric cardia[11], liver[13], gallbladder[56], pancreas[21], and kidney[5]. The relative risk for esophageal adenocarcinoma is even higher, up to 4 fold in those who are extremely obese.
The International Agency for Research on Cancer (IARC) has concluded that excess body weight increases risk for many types of cancer[2]: esophagus, colon, rectum, kidney, pancreas, uterus, ovary, post-menopausal breast, stomach cardia, liver, gallbladder, meningioma, thyroid, and multiple myeloma.
Patients with gastric bypass surgery had a lower risk of cancer incidence and mortality compared to severely obese patients[43][34].

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