abstract: Cancer among patients with diabetes, obesity and abnormal blood lipids: a population-based register study in Sweden.

Blogger's Note: see also posting regarding BRCA1/heart disease/doxorubicin research... (blog posting Apr 3 eg. as per below abnormal lipid levels/ovarian cancer)

                ~~~~~~~~~~~~~~~~

Cancer among patients with diabetes, obesity and abnormal blood lipids: a population-based register study in Sweden.

Abstract

OBJECTIVE:

To study how the incidence of cancer is related to diabetes, obesity or abnormal blood lipids.

METHODS:

Diagnosis of diabetes, obesity or abnormal blood lipids was studied 0-10 years prior to the diagnosis of cancer in 19,756 cases of cancer and in 147,324 controls matched regarding age, sex and domicile.

RESULTS:

Diabetes was significantly more common prior to diagnosis in patients with liver, pancreatic, colon and urinary tract/bladder cancer and in patients with breast cancer diagnosed with diabetes 0-4 years prior to the cancer diagnosis. A lower risk of diabetes was seen in patients with prostate carcinoma among individuals with diabetes diagnosed 5-10 years prior to the cancer diagnosis. The findings remained after adjusting for obesity and high blood lipids. Obesity was significantly more common in patients with endometrial, colon and kidney cancer and with breast cancer above the age of 60 years in those where obesity was diagnosed close to the diagnosis of cancer. High blood lipids were significantly more common in patients with ovarian cancer and less common in patients with breast cancer.

CONCLUSIONS:

The study confirms some previous findings concerning comorbidity and cancer and highlights some new ones.

abstract: Does Significant Medical Comorbidity Negate the Benefit of Up-front Cytoreduction in Advanced Ovarian Cancer?

Does Significant Medical Comorbidity Negate the Benefit of Up-front Cytoreduction in Advanced Ovarian Cancer?

Background:
The objective of the study was to determine if initial surgery (IS) or initial chemotherapy (IC) affects rates of optimal surgery and survival in a population with significant medical comorbidities.

Conclusions:
The achievement of optimal cytoreduction continues to be a significant predictor of survival, regardless of treatment approach. Patients selected for IS and in whom optimal cytoreduction was achieved had improvements in both progression-free survival and overall survival. However, the differences could not be explained by surgical effort alone as diabetes was independently associated with mortality.

abstract: Time-varying incidence of cancer after the onset of type 2 diabetes: evidence of potential detection bias British Columbia, Canada

Time-varying incidence of cancer after the onset of type 2 diabetes: evidence of potential detection bias.:

Diabetologia. 2011 Sep;54(9):2263-71

Abstract

AIMS/HYPOTHESIS:
Despite the vast body of epidemiological literature on the risk of cancer in people with diabetes, few studies have examined the pattern of cancer risk during different time windows following diabetes onset. The objective of the study was to examine the risks of site-specific cancer in people with incident type 2 diabetes during different time windows following diabetes onset.

METHODS: 

This was a population-based retrospective cohort study. The study period was 1 April 1994 to 31 March 2006; censoring occurred at 31 March 2006, at death or on departure from British Columbia, Canada. Using linked health databases, we identified incident cohorts with and without diabetes, who were matched by age, sex and index year. Following a minimum 2-year cancer washout period, first site-specific cancers were identified prospectively in both cohorts.

RESULTS: 

Within 3 months following diabetes onset, participants with diabetes had significantly increased risks of colorectal, lung, liver, cervical, endometrial, ovarian, pancreatic and prostate cancers. After the initial 3-month period, the risks for colorectal (HR 1.15, 95% CI 1.05, 1.25), liver (HR 2.53, 95% CI 1.93, 3.31) and endometrial (HR 1.58, 95% CI 1.28, 1.94) cancers remained significantly elevated compared with those without diabetes.

The diabetes cohort remained at increased risk of pancreatic cancer in later years, but followed a different pattern: HR 3.71 at 3 months-1 year, 2.94 at 1-2 years, 1.78 at 2-3 years and 1.65 at 3-10 years (p value for all <0.01). After an initial period of elevated risk, men with type 2 diabetes subsequently had a decreased risk of prostate cancer (HR 0.82, 95% CI 0.76, 0.88).

CONCLUSIONS/INTERPRETATION: 

People with type 2 diabetes are at increased risk of select cancers; this risk is particularly elevated at the time of diabetes onset, which is likely to be due to increased ascertainment.

Medical News: Statins Up Diabetes Risk in Older Women - in Primary Care, Diabetes from MedPage Today (2nd article)

Action Points

---

• This study found that older women who take statins may be at an increased risk for developing type 2 diabetes.
• Note that the risk was seen with all types of statins.

"Older women who take statins may be at an increased risk for developing type 2 diabetes, researchers found.

In an analysis of data from the Women's Health Initiative, postmenopausal women who were on a statin at study entry had almost a 50% greater risk of diabetes than those who weren't on the cholesterol-lowering drugs, Yunsheng Ma, MD, PhD, of the University of Massachusetts School of Medicine, and colleagues reported online in the Archives of Internal Medicine.

"This study urges us to further evaluate the risk-benefit profile of statins," Ma told MedPage Today, adding that the ratio will likely vary by patient population....."

WEBMD: Statins May Raise Diabetes Risk in Older Women (short and longterm use)

Relationship of Type II Diabetes and Metformin Use to Ovarian Cancer Progression, Survival, and Chemosensitivity

Use of metformin and the risk of ovarian cancer: A case-control analysis

OBJECTIVE:

To explore the association between use of metformin or other antidiabetic drugs and the risk of ovarian cancer.

CONCLUSION:

In this large epidemiological study long-term use of metformin, but not of sulfonylureas, was associated with a tendency towards a decreased risk of ovarian cancer. Long-term use of insulin was associated with an increased risk of ovarian cancer.

Postmenopausal Hormone Therapy: An Endocrine Society Scientific Statement -- Concensus Statement/Review

Conclusions:
The major conclusions related to the overall benefits and risks of MHT expressed as the number of women per 1000 taking MHT for 5 yr who would experience benefit or harm. Primary areas of benefit included relief of hot flashes and symptoms of urogenital atrophy and prevention of fractures and diabetes. Risks included venothrombotic episodes, stroke, and cholecystitis. In the subgroup of women starting MHT between ages 50 and 59 or less than 10 yr after onset of menopause, congruent trends suggested additional benefit including reduction of overall mortality and coronary artery disease. In this subgroup, estrogen plus some progestogens increased the risk of breast cancer, whereas estrogen alone did not. Beneficial effects on colorectal and endometrial cancer and harmful effects on ovarian cancer occurred but affected only a small number of women. Data from the various Women's Health Initiative studies, which involved women of average age 63, cannot be appropriately applied to calculate risks and benefits of MHT in women starting shortly after menopause.
At the present time, assessments of benefit and risk in these younger women are based on lower levels of evidence.

free full access: Diabetes and Cancer: A Consensus Report -- A Cancer Journal for Clinicians

"Because specific antihyperglycemic medications are associated with cancer risk factors, confounding by unmeasured or incompletely measured risk factors may explain at least in part the previously reported associations between medications and cancer. To our knowledge, few studies to date have examined the risk associated with the dose, duration, or recency of medication use, which might inform the biologic plausibility of observed associations. Many agents that affect carcinogenesis have long latencies or require a minimum exposure level, and the risk associated with some agents may return to baseline after the exposure has been terminated for a period of time. Some diabetes medications have only recently come on the market (eg, TZDs, insulin analogs, and incretin-based therapies), and therefore, studies of these agents will only assess the cancer risk associated with relatively short-term use.

It is unlikely that the effect of diabetes therapies on cancer risk and progression, particularly at specific cancer sites, will be fully addressed with randomized controlled clinical trials, due to both cost and follow-up time limitations.

Risk of Cancer Following Hospitalization for Type 2 Diabetes The Oncologist

ABSTRACT
Objectives. Cancer and type 2 diabetes (T2D) are two common diseases that may share risk factors. We aimed at determining subsequent cancer risks in patients hospitalized for T2D in Sweden.
Methods. T2D patients were obtained from the nationwide Hospital Discharge Register; cancers were recorded from the Swedish Cancer Registry. Standardized incidence ratios (SIRs) were calculated for cancer
following last hospitalization for T2D. The comparison group was the general Swedish population.
Results. The number of hospitalized T2D patients from 1964 to 2007 was 125,126, of whom 26,641 had an affected family member. Altogether 24 cancers showed an elevated risk when follow-up was started after the
last hospitalization. The highest SIRs were for pancreatic (6.08) and liver (4.25) cancers. The incidences of these cancers were even elevated when follow-up was started 5 years after the last hospitalization for T2D, with primary liver cancer showing the highest SIR of 4.66. Also increased were the incidences of upper aerodigestive tract, esophageal, colon, rectal, pancreatic, lung, cervical, endometrial, ovarian, and kidney cancers. Prostate cancer showed a lower risk. Familial T2D patients showed no exceptional elevated cancer risks but their prostate cancer and melanoma risks were lower.
Conclusions. This study, covering approximately one half of Swedish T2D patients, showed an elevated risk for several cancers after hospitalization for T2D, probably indicating the profound metabolic disturbances of the underlying disease. The highest risks were found for
liver and pancreatic cancers. No excess cancer risks were observed in familial diabetics. The lower risk for prostate cancer remains intriguing 

(ovarian cancer incidence rates 15.61/per 100,000 population; risk 1.84 (>1.0 = increased risk)

Diabetes Raises Risk For Post-Surgical Mortality In Cancer Patients

"Care of diabetes before, during and after surgery is very important," Dr. Yeh said. "It should be part of the preoperative discussion."