Johns Hopkins Diabetes GuideComplications and ComorbiditiesHematology Malignancy

Cancer and Diabetes

Hsin-Chieh Yeh, Ph.D., Frederick Brancati, M.D., M.H.S.
Cancer and Diabetes is a topic covered in the Johns Hopkins Diabetes Guide.

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EPIDEMIOLOGY

Incident Cancer:

  • Diabetes associated with increased risk of non-Hodgkin lymphoma[20] and cancer of breast,[26] colorectum,[33] endometrium,[25] liver[29], and pancreas[34].
  • Negatively associated with risk of prostate cancer[28].
  • Hypotheses about possible link between diabetes and cancer include:
    • Insulin is known to stimulate cell proliferation[35].
    • Hyperglycemia promotes tumor growth[39][21].
    • Shared risk factors such as obesity[35], diet, physical inactivity[35], hepatitis C[22], NAFLD[30].

Diabetes and cancer death

  • 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,
    • increased risk of death from breast cancer in women[38]
  • Also reported positive associations with death from:
    • esophagus, liver, and colon/rectum cancers in men, and
    • liver and cervix cancers in women[36]

Diabetes in Cancer Patients

  • 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[13][10].
  • Meta-analysis showed diabetes associated with increased odds of postoperative mortality across all cancer types [HR=1.5][13].
  • Hyperglycemia associated with shorter duration of complete remission in patients with acute lymphocytic leukemia[37].
  • Hyperglycemia associated with shorter survival in patients with newly diagnosed glioblastoma[17].

Diabetes and Prostate Cancer

  • Negatively associated with risk of prostate cancer[28].
  • Androgen deprivation therapy causes changes in body composition, alterations in lipid profiles, and decreased insulin sensitivity[11].
  • Androgen deprivation therapy significantly increased risk for diabetes mellitus[18].

Obesity and Cancer

  • A meta-analysis[23] showed BMI strongly associated with:
    • oesophageal adenocarcinoma (RR 1.52), thyroid (RR 1.33), colon (RR 1.24), and renal (RR 1.24) cancers. (all p< 0.001 )
    • endometrial (RR 1.59), gallbladder (RR 1.59), esophageal (RR 1.51), and renal (RR 1.34) cancers in women. (all p< 0.05)
    • weaker positive associations with cancer and malignant melanoma in men
  • Patients with gastric bypass surgery had a lower risk of cancer incidence and mortality compared to severely obese patients[27][19]

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Last updated: June 24, 2013