Diabetes and cancer are common diseases with tremendous impact on health and healthcare worldwide expenditure. A growing number of epidemiological and clinical studies find evidence suggesting that diabetes is directly linked to an increased risk of developing certain types of cancer.[1] Now, researchers in The Netherlands have performed a unique meta-analysis that excludes all other causes of death and found that diabetic patients not only have an increased risk of developing breast and colon cancer but an even higher risk of dying from them.[2]
Previous studies have examined the association between diabetes and dying from cancer but death from specific types of cancer has not been well-studied. ?Our meta-analysis is the first to combine incidence and death from breast and colon cancer, while excluding all other causes of death. We have investigated the link between diabetes and the risk of developing as well as the risk of dying from these cancers,? eplained Kirstin De Bruijn, a PhD student in the Surgery Department at the Erasmus University Medical Centerin Rotterdam, The Netherlands.
The study, presented at the 2013 European Cancer Congress (ECC2013), held in Amsterdam, The Netherlands, September 27 – October 1, 2013, were prepared by De Bruijn and colleagues. They include results from 20 trials that had taken place between 2007 and 2012, involving more than 1.9 million patients with breast or colon cancer, with or without diabetes.
Increased risk
They researchers found that patients with diabetes had a 23% increased risk of developing breast cancer and a 38% increased risk of dying from the disease compared to non-diabetic patients. Diabetic patients had a 26% increased risk of developing colon cancer and a 30% increased risk of dying from it compared to non-diabetic patients.
De Bruijn further explains: ?The results for breast and colon cancer incidence in patients with diabetes are consistent with other meta-analyses. Furthermore, this meta-analysis shows a higher risk and a stronger association between diabetes and death from breast and colon cancer than previously reported.”
A vulnerable group of individuals
Cancer patients who are obese and diabetic are an already more vulnerable group of individuals when it comes to surgery. They have an increased risk of developing complications both during and after surgery. If more obese and diabetic patients have to have an operation because of cancer, healthcare costs will increase.
This study provides stronger evidence for the association between diabetes and the risk of developing and dying from cancer.
?Worldwide, the numbers of obese and subsequent diabetic patients are still increasing and it is a cause for concern that these individuals are at a higher risk of developing cancer and dying from it. Studies have already highlighted the increased risk of developing cancer for diabetics,” De Bruijn explained. “Our meta-analysis, which is unique since it looks at the risks for breast and colon cancer while excluding all other causes of death, provides stronger evidence for the association between diabetes and the risk of developing and dying from these cancers. We want to make people more aware of this problem and we hope that prevention campaigns regarding obese and diabetic patients will focus on highlighting this increased risk.?
The researchers intend to follow up their work by investigating what effect other factors associated with diabetes have on cancer risk and death, such as the anti-diabetic medication, metformin, as well as insulin and the duration of diabetes. ?It is extremely important that prevention campaigns on obesity and diabetes are intensified and that they also focus on children, to prevent them from becoming obese and developing cancer later in life,? De Bruijn concluded.
Interesting study
?With the increase in incidence of both diabetes and breast cancer, this is an important update of the meta-analyses on this subject and an interesting addition to the literature as this study excluded other causes of death. As the results are consistent with earlier meta-analyses, the substantial increased risk of breast cancer should be part of prevention campaigns. For further research, it would be important to study how other, competing risk factors might affect survival, as elderly cancer patients with diabetes are usually diagnosed with other conditions as well. Additionally, the potential role of metformin in relation to improved survival and cancer recurrence needs to be studied,? said Professor Cornelis van de Velde, MD, Ph.D, the current President of ECCO.
Lifestyle, metabolism, overweight? and cancer
Professor Hans-Joerg Senn, scientific director at the Tumor and Breast Centre ZeTuP, St Gallen, Switzerland, said: ?The message from the Erasmus Medical Center is disturbing and highly important, for the medical community, as well as for the public and politicians. It highlights once more the importance of the negative interactions between lifestyle, metabolism, overweight and certain frequent types of cancers, such as here between diabetes, obesity and breast cancer as well as colon cancer. It is time for increased and more effective information and prevention campaigns, especially in the economically developed world, where caloric abundance is prevalent.?
For more information:
[1] Giovannucci E, Harlan DM, Archer MC, Bergenstal RM, Gapstur SM, Habel LA, Pollak M, Regensteiner JG, Yee D. Diabetes and cancer: a consensus report. Diabetes Care. 2010 Jul;33(7):1674-85. doi: 10.2337/dc10-0666.[Article][PubMed][Download]
[2] Abstract no: 1402: A meta-analysis on breast and colorectal cancer in diabetic patients: higher incidences and mortality rates. What: Public Health and Epidemiology, proffered papers session, When: Sunday 29 September 09.00?11.00 a.m. CEST, Where: Elicium 1.
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