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Endocrinology

Risk of Cancer Following Hospitalization for Type 2 Diabetes

^aDivision of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; ^bCenter for Family and Community Medicine, Karolinska Institute, Huddinge, Sweden; ^cCenter for Primary Health Care Research, Lund University, Malmö, Sweden; ^dStanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, USA

Key Words. Diabetes • Cancer • Risk factors • Liver cancer • Prostate cancer

Correspondence: Kari Hemminki, M.D., Ph.D., Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120 Heidelberg, Germany. Telephone: 49-6221-421800; Fax: 49-6221-421810; e-mail: k.hemminki{at}dkfz.de

Received November 30, 2009; accepted for publication April 4, 2010; first published online in THE ONCOLOGIST Express on May 17, 2010.

Disclosures: Kari Hemminki: None; Xinjun Li: None; Jan Sundquist: None; Kristina Sundquist: None.

The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias. No financial relationships relevant to the content of this article have been disclosed by the authors or independent peer reviewers.

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.

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