Anssi Auvinen

University of Tampere, Tammerfors, Pirkanmaa, Finland

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Publications (247)1528.53 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The European Randomized Study of Screening for Prostate Cancer (ERSPC) has shown a 21% reduction in prostate cancer (PCa) mortality and a 1.6-fold increase in PCa incidence with prostate-specific antigen (PSA)-based screening (at 13 yr of follow-up). We evaluated PCa incidence by risk category at diagnosis across the study arms to assess the potential impact on PCa mortality. Information on arm, centre, T and M stage, Gleason score, serum PSA at diagnosis, age at randomisation, follow-up time, and vital status were extracted from the ERSPC database. Four risk categories at diagnosis were defined: 1, low; 2, intermediate; 3, high; 4, metastatic disease. PSA (≤100 or >100 ng/ml) was used as the indicator of metastasis. Incidence rate ratios (IRRs) for screening versus control arm by risk category at diagnosis and follow-up time were calculated using Poisson regression analysis for seven centres. Follow-up was truncated at 13 yr. Missing data were imputed using chained equations. The analyses were carried out on an intention-to-treat basis. In the screening arm, 7408 PCa cases were diagnosed and 6107 in the control arm. The proportion of missing stage, Gleason score, or PSA value was comparable in the two arms (8% vs 10%), but differed among centres. The IRRs were elevated in the screening arm for the low-risk (IRR: 2.14; 95% CI, 2.03-2.25) and intermediate-risk (IRR: 1.24; 95% CI, 1.16-1.34) categories at diagnosis, equal to unity for the high-risk category at diagnosis (IRR: 1.00; 95% CI, 0.89-1.13), and reduced for metastatic disease at diagnosis (IRR: 0.60; 95% CI, 0.52-0.70). The IRR of metastatic disease had temporal pattern similar to mortality, shifted forwards an average of almost 3 yr, although the mortality reduction was smaller. The results confirm a reduction in metastatic disease at diagnosis in the screening arm, preceding mortality reduction by almost 3 yr. The findings of this study indicate that the decrease in metastatic disease at diagnosis is the major determinant of the prostate cancer mortality reduction in the European Randomized study of Screening for Prostate Cancer. Copyright © 2015. Published by Elsevier B.V.
    European Urology 03/2015; DOI:10.1016/j.eururo.2015.02.042 · 10.48 Impact Factor
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    ABSTRACT: Antiarrhythmic drug digoxin has been reported to have apoptosis-inducing and cytotoxic effects on prostate cancer cells. We evaluated the association between antiarrhythmic drug use and prostate cancer risk in a population-based case-control study. The study included all new prostate cancer cases diagnosed in Finland during 1995-2002 and matched controls (24,657 case-control pairs) obtained from the Finnish Cancer Registry and the Population Register Center, respectively. Information on antiarrhythmic drug purchases was obtained from national prescription database. Multivariable-adjusted conditional logistic regression model was used for data analysis. Compared to never-users of antiarrhythmic drugs, we found no significant association between digoxin use and prostate cancer risk overall (OR 0.95, 95% CI 0.89-1.01) or for advanced prostate cancer risk (OR 0.90, 95% CI 0.77-1.05). The result was similar also for other antiarrhythmic drugs, with the exception of sotalol, users of which had decreased risk of advanced prostate cancer (OR 0.73, 95% CI 0.56-0.96). Also the overall prostate cancer risk decreased by duration of sotalol use (p for trend 0.038). We show that digoxin or other common antiarrhythmic drugs generally do not associate with prostate cancer risk at population level during maximum follow-up of eight years. However, we cannot rule out longer-term protective effects of digoxin. K(+) -channel blocker sotalol shows some promise as prostate cancer preventing agent. However, findings need to be confirmed in further studies. This article is protected by copyright. All rights reserved. Copyright © 2015 UICC.
    International Journal of Cancer 02/2015; DOI:10.1002/ijc.29470 · 6.20 Impact Factor
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    ABSTRACT: Background Risk-stratified screening for prostate cancer (PCa) with prostate-specific antigen (PSA) testing incorporating genetic variants has received some attention but has been scarcely investigated. We developed a model to stratify the Finnish population by different risk profiles related to genetic variants to optimize the screening policy.Methods Data from the Finnish randomized controlled trial on screening for PCa with PSA testing were used to estimate a six-state Markov model of disease progression. Blood samples from Finnish men were used to assess the risk of PCa related to three genetic variants (rs4242382, rs138213197, and rs200331695). A risk score-based approach combined with a series of computer simulation models was applied to optimize individual screening policies.ResultsThe 10-year risk of having progressive prostate cancer detected ranged from 43% in the top 5% risk group to approximately 11% in the bottom half of the population. Using the median group, with screening every four years beginning at 55 years-old, as the reference group, the recommended age beginning screening was approximately 47 years-old for the top 5% risk group and 55 years-old for those in the lower 60% risk group. The recommended interscreening interval has been shortened for individuals in the high risk group. The increased availability of genomic information allows the proposed multistate model to be more discriminating with respect to risk stratification and the suggested screening policy, particularly for the lowest risk groups­.­­ConclusionsA multi-state genetic variant-based model was developed for further application to population risk stratification to optimize the interscreening interval and the age at which to begin screening for PSA. A small sub-group of the population is likely to benefit from more intensive screening with early start and short interval, while half of the population is unlikely to benefit from such protocol (compared with four-year interval after age 55 years). Prostate 9999: XX–XX, 2014. © 2015 Wiley Periodicals, Inc.
    The Prostate 02/2015; DOI:10.1002/pros.22964 · 3.57 Impact Factor
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    ABSTRACT: We systematically synthesized the epidemiologic literature on mortality in patients with epilepsy (PWE) by epilepsy-related clinical characteristics with an aggregate data meta-analysis.
    Neurology 10/2014; DOI:10.1212/WNL.0000000000001005 · 8.30 Impact Factor
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    ABSTRACT: Prostate cancer (PC) screening with prostate-specific antigen (PSA) has been shown to decrease PC mortality in the European Randomized Study of Screening for Prostate Cancer (ERSPC). However, in the Finnish trial, which is the largest component of the ERSPC, no statistically significant mortality reduction was observed. We investigated which had the largest impact on PC deaths in the screening arm: nonparticipation, interval cancers or PSA threshold.The screening (SA) and control (CA) arms comprised altogether 80,144 men. Men in the SA were screened at four-year intervals and referred to biopsy if the PSA concentration was ≥4.0 ng/ml, or 3.0-3.99 ng/ml with a free/total PSA ratio ≤16%. The median follow-up was 15.0 years. A counterfactual exclusion method was applied to estimate the effect of three subgroups in the SA: the nonparticipants, the screen-negative men with PSA ≥3.0ng/ml and a subsequent PC diagnosis, and the men with interval PCs.The absolute risk of PC death was 0.76% in the SA and 0.85% in the CA; the observed hazard ratio (HR) was 0.89 (95% confidence interval (CI) 0.76-1.04). After correcting for nonattendance, the HR was 0.78 (0.64-0.96); predicted effect for a hypothetical PSA threshold of 3.0 ng/ml the HR was 0.88 (0.74-1.04) and after eliminating the effect of interval cancers the HR was 0.88 (0.74-1.04).Nonparticipating men in the SA had a high risk of PC death and a large impact on PC mortality. A hypothetical lower PSA threshold and elimination of interval cancers would have had a less pronounced effect on the screening impact. © 2014 Wiley Periodicals, Inc.
    International Journal of Cancer 10/2014; 136(10). DOI:10.1002/ijc.29300 · 6.20 Impact Factor
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    ABSTRACT: Family history (FH) is one of the few known risk factors for prostate cancer (PC). There is also new evidence about mortality reduction in screening of PC with prostate-specific antigen (PSA). Therefore we conducted a prospective study in the Finnish Prostate Cancer Screening Trial to evaluate the impact of family history on outcomes of PC screening. Of the 80,144 men enrolled, 31,866 men were randomized to the screening arm and were invited for screening with PSA test (cut-off 4ng/ml) every 4 years. At the time of the each invitation, family history of prostate cancer (FH) was assessed through a questionnaire. The analysis covered a follow-up to 12 years from randomization for all men with data on family history. Of the 23,702 (74.3%) invited men attending screening, 22,756 (96.0%) provided information of their FH. Altogether 1723 (7.3%) men reported at least one first-degree relative diagnosed with PC and of them 235 (13.6%) were diagnosed with PC. Men with a first-degree FH had increased risk for PC (risk ratio (RR) 1.31, p<0.001) and the risk was especially elevated for interval cancer (RR 1.65, 95% CI 1.27-2.15). Risk for low-grade (Gleason 2-6) tumors was increased (RR 1.46, 95% CI 1.15-1.69), but it was decreased for Gleason 8-10 tumors (RR 0.48, 95% CI 0.25-0.95). PSA test performance (sensitivity and specificity) was slightly inferior for FH positives. No difference in prostate cancer mortality was observed in terms of FH. Our findings provide no support for selective PSA screening targeting men with family history of PC. © 2014 Wiley Periodicals, Inc.
    International Journal of Cancer 10/2014; 136(9). DOI:10.1002/ijc.29243 · 6.20 Impact Factor
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    ABSTRACT: Genome-wide association studies (GWAS) have identified 76 variants associated with prostate cancer risk predominantly in populations of European ancestry. To identify additional susceptibility loci for this common cancer, we conducted a meta-analysis of >10 million SNPs in 43,303 prostate cancer cases and 43,737 controls from studies in populations of European, African, Japanese and Latino ancestry. Twenty-three new susceptibility loci were identified at association P < 5 × 10(-8); 15 variants were identified among men of European ancestry, 7 were identified in multi-ancestry analyses and 1 was associated with early-onset prostate cancer. These 23 variants, in combination with known prostate cancer risk variants, explain 33% of the familial risk for this disease in European-ancestry populations. These findings provide new regions for investigation into the pathogenesis of prostate cancer and demonstrate the usefulness of combining ancestrally diverse populations to discover risk loci for disease.
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    ABSTRACT: We evaluated mortality in relation to a panel of autoimmunity-related immunological serum markers in adult patients with epilepsy (PWE), seen in 1996-7 at the Department of Neurology, Oulu University Hospital in Finland. Blood samples were drawn from 968 volunteers, and baseline measurements included serum immunoglobulins (IgG, IgA, and IgM), and the following antibodies: anticardiolipin, antinuclear, antimitochondrial, antigliadin (A and G), transglutaminase, and endomysial. Hazard ratios (HR) for all-cause mortality in PWE with abnormal immunological markers relative to 413 patients with normal findings were evaluated with adjustment for confounders during a follow-up of nine years. Borderline statistically significant associations were found only for elevated IgA (HR 2.09, 95% CI 0.99–4.42) and for having two or more abnormal antibody titers (HR 1.58, 95% CI 0.98–2.56). The findings of this exploratory study suggested that elevated serum IgA might be associated with excess mortality in PWE.
    Epilepsy Research 09/2014; 108(9). DOI:10.1016/j.eplepsyres.2014.08.014 · 2.19 Impact Factor
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    ABSTRACT: Background The European Randomised study of Screening for Prostate Cancer (ERSPC) has shown significant reductions in prostate cancer mortality after 9 years and 11 years of follow-up, but screening is controversial because of adverse events such as overdiagnosis. We provide updated results of mortality from prostate cancer with follow-up to 2010, with analyses truncated at 9, 11, and 13 years. Methods ERSPC is a multicentre, randomised trial with a predefined centralised database, analysis plan, and core age group (55–69 years), which assesses prostate-specific antigen (PSA) testing in eight European countries. Eligible men aged 50–74 years were identified from population registries and randomly assigned by computer generated random numbers to screening or no intervention (control). Investigators were masked to group allocation. The primary outcome was prostate cancer mortality in the core age group. Analysis was by intention to treat. We did a secondary analysis that corrected for selection bias due to non-participation. Only incidence and no mortality data at 9 years’ follow-up are reported for the French centres. This study is registered with Current Controlled Trials, number ISRCTN49127736. Findings With data truncated at 13 years of follow-up, 7408 prostate cancer cases were diagnosed in the intervention group and 6107 cases in the control group. The rate ratio of prostate cancer incidence between the intervention and control groups was 1·91 (95% CI 1·83–1·99) after 9 years (1·64 [1·58–1·69] including France), 1·66 (1·60–1·73) after 11 years, and 1·57 (1·51–1·62) after 13 years. The rate ratio of prostate cancer mortality was 0·85 (0·70–1·03) after 9 years, 0·78 (0·66–0·91) after 11 years, and 0·79 (0·69–0·91) at 13 years. The absolute risk reduction of death from prostate cancer at 13 years was 0·11 per 1000 person-years or 1·28 per 1000 men randomised, which is equivalent to one prostate cancer death averted per 781 (95% CI 490–1929) men invited for screening or one per 27 (17–66) additional prostate cancer detected. After adjustment for non-participation, the rate ratio of prostate cancer mortality in men screened was 0·73 (95% CI 0·61–0·88). Interpretation In this update the ERSPC confirms a substantial reduction in prostate cancer mortality attributable to testing of PSA, with a substantially increased absolute effect at 13 years compared with findings after 9 and 11 years. Despite our findings, further quantification of harms and their reduction are still considered a prerequisite for the introduction of populated-based screening. Funding Each centre had its own funding responsibility.
    The Lancet 08/2014; 384(9959). DOI:10.1016/S0140-6736(14)60525-0 · 39.21 Impact Factor
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    ABSTRACT: To examine non-cancer morbidity in the Estonian Chernobyl cleanup workers cohort compared with the population sample with special attention to radiation-related diseases and mental health disorders. Register-based cohort study. Estonia. An exposed cohort of 3680 men (cleanup workers) and an unexposed cohort of 7631 men (population sample) were followed from 2004 to 2012 through the Population Registry and Health Insurance Fund database. Morbidity in the exposed cohort compared with the unexposed controls was estimated in terms of rate ratio (RR) with 95% CIs using Poisson regression models. Elevated morbidity in the exposed cohort was found for diseases of the nervous system, digestive system, musculoskeletal system, ischaemic heart disease and for external causes. The most salient excess risk was observed for thyroid diseases (RR=1.69; 95% CI 1.38 to 2.07), intentional self-harm (RR=1.47; 95% CI 1.04 to 2.09) and selected alcohol-related diagnoses (RR=1.25; 95% CI 1.12 to 1.39). No increase in morbidity for stress reactions, depression, headaches or sleep disorders was detected. No obvious excess morbidity consistent with biological effects of radiation was seen in the exposed cohort, with the possible exception of benign thyroid diseases. Increased alcohol-induced morbidity may reflect alcohol abuse, and could underlie some of the higher morbidity rates. Mental disorders in the exposed cohort were probably under-reported. The future challenge will be to study mental and physical comorbidities in the Chernobyl cleanup workers cohort.
    BMJ Open 05/2014; 4(5):e004516. DOI:10.1136/bmjopen-2013-004516 · 2.06 Impact Factor
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    ABSTRACT: Twenty-five years have passed since the Chernobyl accident, but its health consequences remain to be well established. Finland was one of the most heavily affected countries by the radioactive fallout outside the former Soviet Union. We analyzed the relation of the estimated external radiation exposure from the fallout to cancer incidence in Finland in 1988-2007. The study cohort comprised all approximately 3.8 million Finns who had lived in the same dwelling for 12 months following the accident (May 1986-April 1987). Radiation exposure was estimated using data from an extensive mobile dose rate survey. Cancer incidence data were obtained for the cohort divided into four exposure categories (the lowest with the first-year committed dose <0.1 mSv and the highest ≥0.5 mSv) allowing for a latency of five years for leukemia and thyroid cancer, and 10 years for other cancers. Of the eight pre-defined cancer sites regarded as radiation-related from earlier studies, only colon cancer among women showed an association with exposure from fallout (excess rate ratio per increment in exposure category 0.06, 95% confidence interval 0.02-0.11). No such effect was observed for men, or other cancer sites. Our analysis of a large cohort over two decades did not reveal an increase in cancer incidence following the Chernobyl accident, with the possible exception of colon cancer among women. The largely null findings are consistent with extrapolation from previous studies suggesting that the effect is likely to remain too small to be empirically detectable and of little public health impact. © 2013 Wiley Periodicals, Inc.
    International Journal of Cancer 05/2014; 134(9). DOI:10.1002/ijc.28554 · 6.20 Impact Factor
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    CancerSpectrum Knowledge Environment 04/2014; 106(5). DOI:10.1093/jnci/dju079 · 14.07 Impact Factor
  • The Journal of Urology 04/2014; 191(4):e832. DOI:10.1016/j.juro.2014.02.2262 · 3.75 Impact Factor
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    ABSTRACT: Understanding the impact of multiple genetic variants and their interactions on the disease penetrance of familial multiple prostate cancer is very relevant to the overall understanding of carcinogenesis. We assessed the joint effect of two loci on rs4242382 at 8q24 and rs10486567 at 7p15.2 to this end. We analyzed the data from a Finnish family-based genetic study, which was composed of 947 men including 228 cases in 75 families, to evaluate the respective effects of the two loci on the disease penetrance; in particular, the occurrence and number of prostate cancer cases within a family were utilized to evaluate the interactions between the two loci under the additive and multiplicative Poisson regression models. The risk alleles A at rs4242382 (OR = 1.14, 95% CI 1.08-1.19, P<0.0001) and a risk allele A at rs10486567 (OR = 1.06, 96%CI 1.01-1.11, P = 0.0208) were found to be associated with an increased risk of familial PrCa, especially with four or more cases within a family. A multiplicative model fitted the joint effect better than an additive model (likelihood ratio test X(2) = 13.89, P<0.0001). The influence of the risk allele A at rs10486567 was higher in the presence of the risk allele A at rs4242382 (OR = 1.09 (1.01-1.18) vs. 1.01 (0.95-1.07)). Similar findings were observed in non-aggressive PrCa, but not in aggressive PrCa. We demonstrated that two loci (rs4242382 and rs10486567) are highly associated with familial multiple PrCa, and the gene-gene interaction or statistical epistasis was consistent with the Fisher's multiplicative model. These loci's association and epistasis were observed for non-aggressive but not for aggressive tumors. The proposed statistical model can be further developed to accommodate multi-loci interactions to provide further insights into epistasis.
    PLoS ONE 02/2014; 9(2):e89508. DOI:10.1371/journal.pone.0089508 · 3.53 Impact Factor
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    ABSTRACT: No study has compared the bothersomeness of all lower urinary tract symptoms (LUTS) using a population-based sample of adults. Despite this lack of evidence, investigators have often cited their LUTS of interest as the "most bothersome" or "one of the most bothersome." To compare the population- and individual-level burden of LUTS in men and women. In this population-based cross-sectional study, questionnaires were mailed to 6000 individuals (18-79 yr of age) randomly identified from the Finnish Population Register. The validated Danish Prostatic Symptom Score questionnaire was used for assessment of bother of 12 different LUTS. The age-standardized prevalence of at least moderate bother was calculated for each symptom (population-level burden). Among symptomatic individuals, the proportion of affected individuals with at least moderate bother was calculated for each symptom (individual-level bother). A total of 3727 individuals (62.4%) participated (53.7% female). The LUTS with the greatest population-level burden were urgency (7.9% with at least moderate bother), stress urinary incontinence (SUI) (6.5%), nocturia (6.0%), postmicturition dribble (5.8%), and urgency urinary incontinence (UUI) (5.0%). Burden from incontinence symptoms was higher in women than men, and the opposite was true for voiding and postmicturition symptoms. At the individual level, UUI was the most bothersome for both genders. Although the response proportion was high, approximately a third did not participate. Both men and women with UUI report moderate or major bother more frequently than individuals with other LUTS. At the population level, the most prevalent bothersome symptoms are urgency, SUI, and nocturia. Urinary urgency was the most common troubling symptom in a large population-based study; however, for individuals, urgency incontinence was the most likely to be rated as bothersome.
    European Urology 01/2014; 65(6). DOI:10.1016/j.eururo.2014.01.019 · 10.48 Impact Factor
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    ABSTRACT: The advantages and disadvantages of two different methods of analyzing the European Randomized Study of Screening for Prostate Cancer (ERSPC) trial with respect to the effect of prostate-specific antigen (PSA) screening on prostate cancer (PCa) mortality (ie, disease-specific mortality analysis and excess mortality analysis) are discussed in depth. The traditional disease-specific mortality is the best end point, but it could be biased by misclassification of causes of death, and it does not take into account the possible effect of the screening process on other causes of death. Excess mortality analysis overcomes these problems, but the results could be biased if the expected mortality is not corrected for attendance status. Both methods, when applied to the ERSPC trials, demonstrate that no increase in non-PCa mortality occurred in the screening group and confirm that PSA screening decreases PCa mortality.
    European Urology 01/2014; 66(3). DOI:10.1016/j.eururo.2013.12.055 · 10.48 Impact Factor
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    ABSTRACT: Commercial airline crew is one of the occupational groups with the highest exposures to ionising radiation. Crew members are also exposed to other physical risk factors and subject to potential disruption of circadian rhythms. This study analyses mortality in a pooled cohort of 93 771 crew members from 10 countries. The cohort was followed for a mean of 21.7 years (2.0 million person-years), during which 5508 deaths occurred. The overall mortality was strongly reduced in male cockpit (SMR 0.56) and female cabin crews (SMR 0.73). The mortality from radiation-related cancers was also reduced in male cockpit crew (SMR 0.73), but not in female or male cabin crews (SMR 1.01 and 1.00, respectively). The mortality from female breast cancer (SMR 1.06), leukaemia and brain cancer was similar to that of the general population. The mortality from malignant melanoma was elevated, and significantly so in male cockpit crew (SMR 1.57). The mortality from cardiovascular diseases was strongly reduced (SMR 0.46). On the other hand, the mortality from aircraft accidents was exceedingly high (SMR 33.9), as was that from AIDS in male cabin crew (SMR 14.0). This large study with highly complete follow-up shows a reduced overall mortality in male cockpit and female cabin crews, an increased mortality of aircraft accidents and an increased mortality in malignant skin melanoma in cockpit crew. Further analysis after longer follow-up is recommended.
    Occupational and environmental medicine 01/2014; 71(5). DOI:10.1136/oemed-2013-101395 · 3.23 Impact Factor
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    ABSTRACT: To evaluate the natural course of lower urinary tract symptoms (LUTS) by quantifying their longitudinal changes. A population-based study of men aged 55, 65, or 75 years in Pirkanmaa region, Finland was conducted with a 5-year follow-up (1999-2004). Mailed self-administered questionnaire with the Danish Prostatic Symptom Score instrument was used to evaluate LUTS. Men with any treatment for LUTS or a history of prostate cancer were excluded. A total of 1331 men were included in the study. All 12 symptoms exhibited considerable fluctuation over time. Incidence of specific symptoms varied by a factor of 10 and remission by a factor of 4. Overall, common symptoms varied most strongly in terms of incidence and remission, whereas the less common ones such as incontinence behaved in a more stable fashion. Remission was more frequent than incidence for all individual LUTS components. The highest incidence was found for post-micturition symptoms and urgency. Remission was most common in weak stream and least frequent in urgency and urgency incontinence. LUTS are dynamic conditions with strong spontaneous fluctuation over time. Remission was more common than incidence. The strong propensity for spontaneous resolution should also be borne in mind in treatment decisions including prescription practices.
    Urology 11/2013; 83(2). DOI:10.1016/j.urology.2013.10.003 · 2.13 Impact Factor
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    ABSTRACT: Background: An association of insulin use and risk of cancer has been reported but evidence is conflicting and methodological issues have been identified. Objective: To summarize results regarding insulin use and cancer risk by a systematic review and meta-analysis of cohort and case-control studies examining risk of cancer associated with insulin use in patients with diabetes. Data sources: Systematic literature search in 5 databases: PubMed, Embase, Web of Science, Scopus and Cochrane Library. Study eligibility criteria (PICOS): Population: diabetes patients. Exposure: users of any exogenous insulin. Comparison: diabetes patients with or without use of antidiabetic drugs. Outcome: any incident cancer. Study design: cohort and case-control studies. Results: 42 eligible studies examined risk of any cancer and 27 site-specific cancers. Results of individual studies were heterogeneous. Meta-analyses were significant for: Insulin vs. no insulin: increased risk for pancreas, liver, kidney, stomach and respiratory cancer, decreased risk for prostate cancer. Insulin vs. non-insulin antidiabetics: increased risk for any, pancreatic and colorectal cancer. Glargine vs. non-glargine insulin: increased risk for breast cancer, decreased risk for colon cancer. Limitations: Few studies available for most cancer sites and exposure contrasts, and few assess effect of dose and duration of exposure. Methodological issues in several studies. Availability of confounders. Conclusions: Insulin use was associated with risk of cancer at several sites. Cautious interpretation of results is warranted as methodological issues and limitations in several of the included studies have been identified. Choice of study design may have a profound effect on estimated cancer risk. Article available through Open Access:
    11/2013; DOI:10.2174/15680266113136660067
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    ABSTRACT: Background: Patients suffering from diabetes mellitus (DM) may experience an increased risk of cancer; however, it is not certain whether this effect is due to diabetes per se. Objective: To examine the association between DM and cancers by a systematic review and meta-analysis according to the PRISMA guidelines. Data sources: The systematic literature search includes Medline at PubMed, Embase, Cinahl,, Cochrane library, Web of Science and SveMed+ with the search terms: "Diabetes mellitus", "Neoplasms", and "Risk of cancer". Study eligibility criteria: The included studies compared the risk of cancer in diabetic patients versus non-diabetic patients. All types of observational study designs were included. Results: Diabetes patients were at a substantially increased risk of liver (RR=2.1), and pancreas (RR=2.2) cancer. Modestly elevated significant risks were also found for ovary (RR=1.2), breast (RR=1.1), cervix (RR=1.3), endometrial (RR=1.4), several digestive tract (RR=1.1-1.5), kidney (RR=1.4), and bladder cancer (RR=1.1). The findings were similar for men and women, and unrelated to study design. Meta-regression analyses showed limited effect modification of body mass index, and possible effect modification of age, gender, with some influence of study characteristics (population source, cancer- and diabetes ascertainment). Limitations: Publication bias seemed present. Only published data were used in the analyses. Conclusions: The systematic review and meta-analysis confirms the previous results of increased cancer risk in diabetes and extends this to additional cancer sites. Physicians in contact with patients with diabetes should be aware that diabetes patients are at an increased risk of cancer.
    11/2013; DOI:10.2174/15748863113086660071

Publication Stats

8k Citations
1,528.53 Total Impact Points


  • 2000–2015
    • University of Tampere
      • • School of Health Sciences
      • • Institute of Biomedical Technology
      • • Department of Public Health
      • • Paediatric Research Centre
      Tammerfors, Pirkanmaa, Finland
  • 2013
    • Tervise Arengu Instituut
      Kolyvan, Harju, Estonia
  • 2004–2013
    • University of Helsinki
      • • Department of Urology
      • • Department of Clinical Chemistry
      Helsinki, Province of Southern Finland, Finland
  • 2002–2013
    • Säteilyturvakeskukseen
      Helsinki, Southern Finland Province, Finland
  • 2012
    • International Agency for Research on Cancer
      • Section of Environment and Radiation
      Lyon, Rhone-Alpes, France
    • National Institute for Health and Welfare, Finland
      Helsinki, Southern Finland Province, Finland
    • Emory University
      • School of Medicine
      Atlanta, Georgia, United States
    • Erasmus Universiteit Rotterdam
      • Department of Urology
      Rotterdam, South Holland, Netherlands
    • McMaster University
      • Department of Clinical Epidemiology and Biostatistics
      Hamilton, Ontario, Canada
  • 1992–2012
    • Finnish Cancer Registry, Helsinki
      Helsinki, Uusimaa, Finland
  • 2001–2010
    • Helsinki University Central Hospital
      • Department of Clinical Chemistry
      Helsinki, Province of Southern Finland, Finland
  • 2009
    • Danish Cancer Society
      København, Capital Region, Denmark
    • Erasmus MC
      • Department of Urology
      Rotterdam, South Holland, Netherlands
  • 2007–2009
    • Research Institute of the Finnish Economy, Finland, Helsinki
      Helsinki, Southern Finland Province, Finland
    • The Ohio State University
      Columbus, Ohio, United States
    • University of Aberdeen
      Aberdeen, Scotland, United Kingdom
    • University of Leicester
      Leiscester, England, United Kingdom
  • 2008
    • Karolinska Institutet
      • Institutet för miljömedicin - IMM
      Solna, Stockholm, Sweden
    • Institute of Cancer Research
      • Division of Genetics and Epidemiology
      Londinium, England, United Kingdom
  • 2005–2006
    • University of Oulu
      Uleoborg, Northern Ostrobothnia, Finland
    • Turku University Hospital
      Turku, Varsinais-Suomi, Finland
    • Tampere University Hospital (TAUH)
      Tammerfors, Province of Western Finland, Finland
    • Kuopio University Hospital
      Kuopio, Northern Savo, Finland
  • 2002–2004
    • Seinäjoki Central Hospital
      Seinäjoki, Province of Western Finland, Finland
  • 1998–2002
    • National Cancer Institute (USA)
      • • Division of Cancer Epidemiology and Genetics
      • • Radiation Epidemiology
      Bethesda, MD, United States