Diabetes mellitus and gastric carcinoma: Is there an association?
Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, NY. Journal of Carcinogenesis
12/2011; 10(1):30. DOI: 10.4103/1477-3163.90481
Diabetes mellitus (DM) has been associated with the risk of several gastrointestinal cancers including liver, pancreas, colon and rectum. However, the evidence is inconclusive for gastric adenocarcinoma (GC). In the current review, we summarize 20 population-based cohort studies that compared GC incidence and mortality between diabetic and non-diabetic population. We discuss the shared risk factors and provide qualitative and quantitative (meta-analytic) summary of the current evidence evaluating the association by high-risk subgroups. The overall risk-estimate based on all studies did not show an increased risk of GC in diabetics. However, 2 cohort studies conducted in East Asian countries, where Helicobacter pylori infection and GC rates are higher, showed a higher risk of GC in diabetics. Additionally, high plasma glucose levels in the presence of Helicobacter pylori infection increased the risk of GC by over four times, suggesting a multiplicative effect. Results from the meta-analysis show that, the risk of GC was also higher in populations with greater prevalence of type 1 DM (relative risk = 1.60), suggesting an insulin-independent carcinogenic process in this subgroup. The risk of mortality due to GC was higher in diabetics compared to non-diabetics (relative risk = 1.62). Although the overall risk estimates do not show an association between DM and GC, complex interactions between infectious, molecular, demographic and host factors may convey a higher risk in certain subgroups. Future studies should be sufficiently powered for detailed subgroup analysis to elucidate the causative and mechanistic association between DM and GC.
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ABSTRACT: Over the last 60 years, Japanese people have experienced a rapid and drastic change in lifestyle, including diet. Suspicions have been raised that so-called ‘Westernization’, characterized by a high-calorie diet and physical inactivity, is associated with increasing trends in the incidence of cancer of the colon, liver, pancreas, prostate, and breast, as well as type 2 diabetes. Epidemiological evidence from our prospective study, the Japan Public Health Center-based Prospective (JPHC) study, and systematic literature reviews generally support the idea that factors related to diabetes or insulin resistance are associated with an increased risk of colon (mostly in men), liver, and pancreatic cancers. These cancers are inversely associated with physical activity and coffee consumption, which are known to decrease the risk of type 2 diabetes. The suggested mechanism of these effects is that insulin resistance and the resulting chronic hyperinsulinemia and increase in bioavailable insulin-like growth factor 1 (IGF1) stimulate tumor growth. In contrast, associations with diabetes are less clear for cancer of the colon in women, and breast and prostate, which are known to be related to sex hormones. The effect of insulin resistance or body fat on sex-hormone production and bioavailability may modify their carcinogenic effect differently from cancers of the colon in men, and liver and pancreas. In conclusion, there is substantial evidence to show that cancers of the colon, liver, and pancreas are associated with insulin resistance, and that these cancers can be prevented by increasing physical activity, and possibly coffee consumption.
(Cancer Sci 2010; 101: 1073–1079)
Available from: Ki Young Son
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ABSTRACT: To systematically assess the association between diabetes and incidence of gastric cancer.
We searched MedLine (PubMed), EMBASE, and the Cochrane Library without any limitations with respect to publication date or language, we also searched the references of qualifying articles. Case-control studies and cohort studies comparing the risk of gastric cancer between diabetic patients and control subjects were included. We excluded studies reporting only standardized incidence ratios without control groups and those that investigated only mortality but not incidence. Seventeen studies met our criteria, and the qualities of these studies were assessed using the Newcastle-Ottawa Quality Assessment Scale. We performed a meta-analysis of pre-existing diabetes and gastric cancer incidence using the DerSimonian-Laird method for random-effects. For subgroup analyses, we separated the studies by study type, region, sex and method to determine confounding factors and reliability. We also conducted subgroup analyses to examine the effects of smoking, Helicobacter pylori (H. pylori) infection, and cancer site. Publication bias was evaluated using Begg's test.
A random-effects model meta-analysis showed an increased gastric cancer risk in diabetic patients [relative risk (RR) = 1.19; 95%CI: 1.08-1.31]. Subgroup analyses indicated that this result persisted in cohort studies (RR = 1.20; 95%CI: 1.08-1.34), in studies on populations of both Western (RR = 1.18; 95%CI: 1.03-1.36) and Eastern countries (RR = 1.19; 95%CI: 1.02-1.38), in a female subgroup (RR=1.24; 95%CI: 1.01-1.52), and in highly qualified studies (RR = 1.17; 95%CI: 1.05-1.31). Moreover, these results persisted when the analysis was confined to studies adjusted for well-known gastric cancer risk factors such as smoking (RR = 1.17; 95%CI: 1.01-1.34) and H. pylori infection (RR = 2.35; 95%CI: 1.24-4.46).
Pre-existing diabetes mellitus may increase the risk of gastric cancer by approximately 19%. This effect seems to be unrelated to geographical region.
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ABSTRACT: Background: Epidemiological studies have shown that diabetes mellitus (DM) is associated with an increased risk of cancer. The aim of this study was to examine the association of diabetes with subsequent internal cancers in an arsenic-exposed area where the prevalence of diabetes is remarkably higher than in the general Taiwan population. Methods: The southwestern cohort was recruited from blackfoot disease (BFD) endemic townships with high arsenic levels in their well water, while the northeastern cohort was recruited from four townships in the Lanyang Basin with low-to-moderate arsenic level in their well water. These two cohorts were combined and a total of 9525 subjects were recruited for the analysis. The disease status of the subjects, including diabetes, hypertension or dyslipidemia, was ascertained through linkage with the computerized Taiwan National Health Insurance (NHI) database, while the cancer status of the subjects was ascertained through linkage with National Cancer Registry and via the NHI database for major illness/injury certificates/catastrophic illness cards. The subjects were followed from study entry through December 31, 2009. Cox regression analysis with time-dependent DM status was used to determine the hazard ratios (HRs) and 95% confidence intervals (Cls) for developing internal malignancies. Results: Diabetic patients had a 58% higher risk of any site internal cancer compared to non-DM individuals (HR, 1.58; 95% CI: 1.39-1.79) after adjusting for age, sex, education level, cigarette smoking, alcohol drinking, geographical location, cumulative arsenic exposure and history of hypertension or dyslipidemia. A significant association of DM with cancers of the stomach (HR, 1.75; 95% CI: 1.12-2.76), colon (HR, 1.76; 95% CI: 1.20-2.59), liver (HR, 2.46; 95% CI: 1.81-3.34), pancreas (HR, 2.80; 95% CI: 1.30-6.20) and lungs (HR, 1.35; 95% CI: 1.04-1.76) was observed. The association with lung, bladder and kidney cancer was largely confined to diabetic patients with arsenic level in consumed water 5001.tg/L, while the association with other cancer sites did not show such an effect. With the adjustment of arsenic exposure, marked attenuation for the association was observed, suggesting high level arsenic exposure plays an important role in the development of diabetes mellitus and concomitantly lung, bladder and kidney cancer.
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