Cancer incidence was ascertained in a population-based cohort of 51,008 patients in Uppsala, Sweden, who were given a discharge diagnosis of diabetes mellitus during 1965–83. Complete follow-up through 1984 with exclusion of the first year of observation showed that the observed number of cancers in females (1,294) was eight percent higher than expected (relative risk [RR]=1.1, 95 percent confidence interval =11.0–1.1), whereas in males the observed number (1,123) was close to the expected (RR=1.0, 0.9–1.1). Significantly increased risks of pancreatic (RR=1.4, 1.2–1.7), primary liver (RR=1.5, 1.2–1.7), and endometrial (RR=1.5, 1.2–1.8) cancers and a lower than expected number of prostatic cancers (RR=0.7, 0.7–09) were found in this cohort of diabetic patients. The excess risk of pancreatic cancer was similar in females and males and evident both during one through four years (RR=1.7, 1.4–2.1) and five through nine years (RR=1.3, 0.9−1.7) of follow-up, but not thereafter. A similar pattern was found for primary liver cancer, but the RRs were generally higher in males than in females.
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References
KesslerII, Cancer mortality among diabetics. JNCI 1970; 44: 673–86.
Wynder EL, Mabuchi K, Mabuchi N, Fortner JG. Epidemiology of cancer of the pancreas. JNCI 1973; 50: 645–67.
Ragozzino MW, MeltonIII JM, Chu CP, Palumbo JP. Subsequent cancer risk in the incidence cohort of Rochester, Minnesota, residents with diabetes mellitus. J Chronic Dis 1982; 35: 13–9.
Whittemore AS, Paffenberger RS, Anderson K, Halpern J. Early precursors of pancreatic cancer in college men. J Chronic Dis 1983; 36: 251–6.
O'Mara BA, Byers T, Schoenfeld E. Diabetes mellitus and cancer risk: a multisite case-control study. J Chronic Dis 1985; 38: 435–41.
Norell S, Ahlbom A, Erwald R, et al. Diabetes, gall stone disease, and pancreatic cancer (Letter). Br J Cancer 1986; 54: 377–8.
Hiatt RA, Klatsky AL, Armstrong MA. Pancreatic cancer, blood glucose and beverage consumption. Int J Cancer 1988; 41: 794–7.
Cuzick J, Babiker AG. Pancreatic cancer, alcohol, diabetes mellitus and gallbladder disease. Int J Cancer 1989; 43: 415–21.
Lawson DH, Gray JMB, McKillop C, Clarke J, Lee FD, Patrick RS. Diabetes mellitus and primary hepatocellular carcinoma. Q J Med 1986; 61: 945–55.
MacMahon B. Risk factors for endometrial cancer. Gynecol Oncol 1974; 2: 122–9.
Elwood JM, Cole P, Rothman KJ, Kaplan SD. Epidemiology of endometrial cancer. JNCI 1977; 59: 1055–60.
Lin RS, KesslerII. A multi-factorial model for pancreas cancer in man-epidemiologic evidence. JAMA 1981; 245: 147–52.
Goldstein HR. No association found between coffee and cancer of the pancreas (Letter). N Engl J Med 1982; 306: 997.
Heuch I, Kvå;le G, Jacobsen BK, Bjelke E Use of alcohol, tobacco and coffee, and risk of pancreatic cancer. Br J Cancer 1983; 48: 637–43.
Gold EB, Gordis L, Diener MD, et al. Diet and other risk factors for cancer of the pancreas. Cancer Res 1985; 55: 460–7.
Mack TM, Yu MC, Hanisch R, Henderson BE. Pancreas cancer and smoking, beverage consumption, and past medical history. JNCI 1986; 76: 49–60.
Dahlquist GG, Blom LG, Persson LÅ, Sandström AIM, Wall SGI. Dietary factors and the risk of developing insulin dependent diabetes in the childhood. Br Med J 1990; 300: 1302–6.
Drell DW, Notkins AL. Multiple immunological abnormalities in patients with type 1 (insulin-dependent) diabetes mellitus. Diabetologia 1987; 30: 132–43.
Reaven GM. Role of insulin resistance in human disease. Diabetes 1988; 37: 1595–607.
Barrett-Connor E, Khaw KT, Yen SS. Endogenous sex hormone levels in older adult men with diabetes mellitus. Am J Epidemiol 1990; 132: 895–901.
Naessén T, Parker R, Persson I, Zack M, Adami HO. Time trends in incidence rates of first hip fracture in the Uppsala Health Care Region, Sweden, 1965–1983. Am J Epidemiol 1989; 130: 289–99.
Swedish Cancer Registry. Cancer Incidence in Sweden 1965–1985 (Annual publications). Stockholm, Sweden: National Board of Health and Welfare, 1969–89.
BailarIII JC, Ederer P. Significance factors for the ratio of a Poisson variable to its expectation. Biometrics 1964; 20: 639–43.
Jain M, Howe GR, St. Louis P, Miller AB. Coffee and alcohol as determinants of risk of pancreas cancer: a case-control study from Toronto. Int J Cancer 1991; 47: 384–9.
Mack TM, Pancreas. In: Schottenfeld D, Fraumeni JFJr, eds., Cancer Epidemiology and Prevention. Philadelphia, PA: WB Saunders, 1982: 638–67.
Ben G, Gnudi L, Maran A, et al. Effects of chronic alcohol intake on carbohydrate and lipid metabolism in subjects with type II (non-insulin-dependent) diabetes mellitus. Am J Med 1991; 90: 70–6.
International Agency for Research on Cancer. Alcohol Drinking. Lyon, France: IARC 1988; IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Vol. 44.
Flyvbjerg A, Orskov H. Growth hormone, insulin-like growth factors and diabetes. In: Alberti KGMM, Krall LP, eds, The Diabetes Annual 5. Amsterdam: Elsevier Science Publishers, BV, 1990: 642–56.
Henderson JR, Daniel PM, Fraser P. A e pancreas as a single organ: The influence of the endocrine upon the exocrine part of the gland. Gut 1981; 22: 158–67.
Grill V, Gutniak M, Roovete A, Efendic S. A stimulating effect of glucose on somatostatin release is impaired in non-insulin-dependent diabetes mellitus. J Clin Endocrinol Metab 1984; 59: 293–7.
Lamberts SW, Krenning EP, Klljn JGM, Reubi JC. The clinical use of somatostatin analogues in the treatment of cancer. Baillière's Clin Endocrinol Metab 1990; 4: 29–49.
Liebow C, Hierowski M, Sapin K. Hormonal control of pancreatic cancer growth. Pancreas 1986; 1: 44–8.
Chou CK, Ho LT, Ting LP, et al. Selective suppression of insulin-induced proliferation of cultured human hepatoma cells by somatostatin. J Clin Invest 1987; 79: 175–8.
Kelsey JL, Hildreth NG. Breast and Gynecologic Cancer Epidemiology. Elorida: CRC Press Inc, 1983: 71–91.
Pettersson, B. Risk factors for endometrial carcinoma. A case-control study (Dissertation). Uppsala, Sweden: Aeta Universitatis Upsaliensis, 1985.
Grönroos M, Tyrkko J, Siiteri PK, Salmi T, Haataja M, Paul R. Cytolysis and karyopyknosis in postmenopausal vaginal smears as markers of endometrial cancer, diabetes and obesity. Studies based on a ten-year follow-up. Acta Cytol 1986; 30: 628–32.
Chodak GW, Schoenberg HW. Progress and problems in screening for carcinoma of the prostate. World J Surg 1989; 13: 60–4.
Ross RK, Paganini-Hill A, Henderson BE. Epidemiology of prostatic cancer. In: Skinner DG, Lieskovsky G, eds. Diagnosis and Management of Genitourinary Cancer. Philadelphia, PA: WB Saunders, 1988: 40–5.
Fushimi H, Horie H, Kameyama M, et al. Low testosterone levels in diabetic men and animals: a possible role in testicular impotence. Diabetes Res Clin Pract 1989; 6: 297–301.
Madsbad S, Gluud C, Bennett P, Krarup T. Rapid changes in plasma androgens during insulin withdrawal in male type 1 (insulin-dependent) diabetics. J Endocrinol Invest 1986; 9: 21–5.
Small M, MacRury S, Beastall GH, MacCuish AC. Oestradiol levels in diabetic men with and without previous myocardial infarction. Q J Med 1987; 64: 617–23.
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Drs Adami and Ekbom are with the Cancer Epidemiology Unit, University Hospital, Uppsala, Sweden; Dr Ekbom is also in the Department of Surgery. Drs McLaughlin and Silverman are with the Biostatistics Branch, National Cancer Institute, Bethesda, Maryland, USA. Dr Berne is in the Department of Internal Medicine, University Hospital, Uppsala, Sweden. Mr Hacker is with Information Management Services, Silver Spring, Maryland, USA. Dr Persson is in the Department of Obstetrics and Gynaecology, University Hospital, Uppsala, Sweden. Address correspondence to Dr Adami, Cancer Epidemiology Unit, University Hospital, S-751 85 Uppsala, Sweden. This research was supported by grants from the Swedish Cancer Society.
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Adami, HO., McLaughlin, J., Ekbom, A. et al. Cancer risk in patients with diabetes mellitus. Cancer Causes Control 2, 307–314 (1991). https://doi.org/10.1007/BF00051670
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DOI: https://doi.org/10.1007/BF00051670