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Sex differences in obesity related cancer incidence in relation to type 2 diabetes diagnosis (ZODIAC-49)

Schrijnders, D., Hendriks, S. H., Kleefstra, N., Vissers, P. A. J., Johnson, J. A., de Bock, G. H., Bilo, H. J. G. & Landman, G. W. D., 25-Jan-2018, In : PLoS ONE. 13, 1, 17 p., 0190870.

Research output: Contribution to journalArticleAcademicpeer-review

Background

Diabetes and obesity seem to be partly overlapping risk factors for the development of obesity- related cancer (mainly breast, prostate and colorectal cancer) in patients with type 2 diabetes (T2DM). In the general population, women have a lower risk for obesity-related cancer compared to men. Previous studies involving cardiovascular disease have shown that T2DM eliminates a female advantage of lower CVD risk in the general population compared to men. It is unclear whether the same could be true for obesity-related cancer. This study aimed to this investigate obesity-related cancer incidence in women and men known with T2DM as compared to the Dutch general population.

Methods

This study included 69,583 patients with T2DM selected from a prospective primary care cohort, which was linked to the Dutch National Cancer Registry to obtain cancer specific data. Obesity-related cancers included liver, kidney, colorectal, gallbladder, pancreas, ovarian, endometrial, advanced prostate cancer, post-menopausal breast cancer and oesophageal adenocarcinoma. Primary outcome was sex-stratified, age and year of cancer diagnosis adjusted standardized incidence ratios (SIRs) for three time periods: 5 years before, the year after diagnosis and the next 4 years after T2DM diagnosis. The Dutch general population was used as reference group.

Results

Women with T2DM were at an increased risk for obesity-related cancer compared to women in the general population already 5 years before diabetes diagnosis (SIR 1.77; 95% CI: 1.63 +/- 1.91). In both men and women, there was a peak in obesity-related cancer incidence following diabetes diagnosis (SIR: 1.38; 95% CI 1.11 +/- 1.64 and SIR: 2.21; 95% CI 1.94-2.30, respectively). From the second to the fifth year after diabetes diagnosis the obesity-related cancer incidence was higher in women compared to women in the general population (SIR: 2.12; 95% CI 1.94 +/- 2.30).

Conclusions

Women with T2DM seem to have a substantially higher obesity-related cancer risk. As opposed to men, in women this risk was already increased years before diabetes diagnosis. These results could imply that a relative advantage of women in the general population with regard to cancer risk is lost in women with T2DM.

Original languageEnglish
Article number0190870
Number of pages17
JournalPLoS ONE
Volume13
Issue number1
Publication statusPublished - 25-Jan-2018

    Keywords

  • BODY-MASS INDEX, BREAST-CANCER, DETECTION BIAS, SOCIOECONOMIC-STATUS, PROSPECTIVE COHORT, INCREASED RISK, INSULIN LEVELS, WEIGHT-GAIN, WOMEN, MELLITUS

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