Colorectal cancer: another complication of diabetes mellitus?

Delayed stool transit and other gastrointestinal abnormalities are commonly observed in persons with diabetes mellitus and are also known to be associated with colorectal cancer. Previous studies of the contribution of diabetes to colorectal cancer incidence and mortality have been limited by small sample sizes and failure to adjust for covariates. With more than 1 million respondents, the 1959-1972 Cancer Prevention Study provided a unique opportunity to explore whether persons with diabetes (n=15,487) were more likely to develop colorectal cancer during a 13-year follow-up period than were persons without diabetes (n=850,946). After adjustment for colorectal cancer risk factors, such as race, educational level, body mass index, smoking, alcohol use, dietary intake, aspirin use, physical activity, and family history of colorectal cancer, the incidence density ratio comparing colorectal cancer in those with diabetes and those without diabetes was 1.30 (95% confidence interval 1.03-1.65) for men and 1.16 (95% confidence interval 0.87-1.53) for women. However, diabetes was not associated with greater case fatality. Future studies should explore the possibility of a cancer-promoting gastrointestinal milieu, including delayed stool transit and elevated fecal bile acid concentrations, associated with hyperglycemia and diabetic neuropathy.

[1]  L. Sobin,et al.  Colon and Rectum , 1998 .

[2]  P. Wingo,et al.  Long-term cancer patient survival in the United States. , 1998, Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology.

[3]  P. Ernst,et al.  Environmental factors , 1957 .

[4]  O. Axelson,et al.  Case-control study on colon cancer regarding previous diseases and drug intake. , 1996, International journal of oncology.

[5]  M. Laakso,et al.  Gastrointestinal symptoms in middle-aged diabetic patients. , 1993, Scandinavian journal of gastroenterology.

[6]  M. Marmot,et al.  Post-challenge glucose concentration, impaired glucose tolerance, diabetes, and cancer mortality in men. , 1992, American journal of epidemiology.

[7]  J. Potter,et al.  Reconciling the epidemiology, physiology, and molecular biology of colon cancer. , 1992, JAMA.

[8]  V. Barriales,et al.  [Heart disease and diabetes]. , 1991, Medicina clinica.

[9]  C. la Vecchia,et al.  History of selected diseases and the risk of colorectal cancer. , 1991, European journal of cancer.

[10]  A. Dyer,et al.  Post-load plasma glucose and cancer mortality in middle-aged men and women. 12-year follow-up findings of the Chicago Heart Association Detection Project in Industry. , 1990, American journal of epidemiology.

[11]  D. Singer,et al.  Screening for diabetes mellitus. , 1988, Annals of internal medicine.

[12]  L F Watson,et al.  Colorectal cancer risk, chronic illnesses, operations and medications: case control results from the Melbourne Colorectal Cancer Study. 1988. , 2007, International journal of epidemiology.

[13]  K. Hellström,et al.  Cholesterol biosynthesis in nonketotic diabetics before and during insulin therapy. , 1987, Diabetes research and clinical practice.

[14]  P. Bennett,et al.  Prevalence of Diabetes and Impaired Glucose Tolerance and Plasma Glucose Levels in U.S. Population Aged 20–74 Yr , 1987, Diabetes.

[15]  K. Hellström,et al.  Cholesterol and bile acid metabolism in middle-aged diabetics. , 1986, Diabete & metabolisme.

[16]  L. Garfinkel.  Selection, follow-up, and analysis in the American Cancer Society prospective studies. , 1985, National Cancer Institute monograph.

[17]  L. Schiller,et al.  Disorders of gastrointestinal motility associated with diabetes mellitus. , 1983, Annals of internal medicine.

[18]  S. Grundy,et al.  Metabolism of Cholesterol and Plasma Triglycerides in Nonketotic Diabetes Mellitus , 1982, Diabetes.

[19]  C. Saudek,et al.  Cholesterol Metabolism in Diabetes: I. The Effect of Diabetic Control on Sterol Balance , 1978, Diabetes.

[20]  S. Grundy,et al.  Effects of diabetes mellitus on cholesterol metabolism in man. , 1977, The New England journal of medicine.

[21]  I. I. Kessler.  Cancer mortality among diabetics. , 1970, Journal of the National Cancer Institute.

[22]  E. Wynder,et al.  Environmental factors of cancer of the colon and rectum , 1967, Cancer.

[23]  S. Gupta,et al.  The causes of death in diabetes mellitus. , 1966, The Journal of the Association of Physicians of India.

[24]  N. Mayne.  Neuropathy in the diabetic and non-diabetic populations. , 1965, Lancet.

[25]  D. Phear,et al.  The causes of death in diabetes mellitus: a study of diabetic mortality in the Royal Adelaide Hospital from 1956 to 1960. , 1963, The Medical journal of Australia.

[26]  James M. Steele,et al.  Relationship Between Diabetes Mellitus and Cancer: A Study of the Records for Eight Years at the Robert Packer Hospital , 1961, The Guthrie Journal.

[27]  Maddox Jk,et al.  Diabetic mortality in Australia. , 1958 .

[28]  Bell Et.  Carcinoma of the pancreas. I. A clinical and pathologic study of 609 necropsied cases. II. The relation of carcinoma of the pancreas to diabetes mellitus. , 1957 .

[29]  H. O. Lancaster,et al.  DIABETIC MORTALITY IN AUSTRALIA , 1950, Australasian annals of medicine.

[30]  P. Jacobson.  A statistical study of cancer among diabetics. , 1948, The Milbank Memorial Fund quarterly.

[31]  A. Marble.  Diabetes and Cancer , 1934 .

[32]  E. B. Wilson,et al.  Cancer and Tuberculosis with Some Comments on Cancer and Other Diseases , 1932 .

[33]  H. Strauss.  Wechselbeziehungen zwischen Karzinom und Diabetes , 1917 .

[34]  E. Joslin.  Causes of Death in Diabetes , 1916 .

[35]  D W Beaven,et al.  Screening for diabetes mellitus. , 1999, The New Zealand medical journal.

[36]  T. Nakamura,et al.  Fecal excretions of hydroxy fatty acid and bile acid in diabetic diarrheal patients. , 1993, Journal of diabetes and its complications.

[37]  B. A. O'Mara,et al.  Diabetes mellitus and cancer risk: a multisite case-control study. , 1985, Journal of chronic diseases.

[38]  L. Melton,et al.  Subsequent cancer risk in the incidence cohort of Rochester, Minnesota, residents with diabetes mellitus. , 1982, Journal of chronic diseases.

[39]  Hammond Ec,et al.  Smoking in relation to the death rates of one million men and women. , 1966 .

[40]  E. C. Hammond,et al.  Smoking in relation to the death rates of one million men and women. , 1966, National Cancer Institute monograph.

[41]  S. Nilsson.  ON THE HEREDITY OF DIABETES MELLITUS AND ITS INTERRELATIONSHIP WITH SOME OTHER DISEASES. , 1964, Acta genetica et statistica medica.

[42]  H. Grosse.  [Diabetes and cancer]. , 1956, Deutsche Zeitschrift fur Verdauungs- und Stoffwechselkrankheiten.

[43]  W. Werner.  [Diabetes mellitus and carcinoma; statistical studies of 25147 sections]. , 1955, Zeitschrift fur Krebsforschung.