Diabetes and Cancer
A consensus report
- Edward Giovannucci, MD, SCD1,*,
- David M. Harlan, MD2,*,
- Michael C. Archer, MA, PHD, DSC3,
- Richard M. Bergenstal, MD4,
- Susan M. Gapstur, PHD5,
- Laurel A. Habel, PHD6,
- Michael Pollak, MD7,
- Judith G. Regensteiner, PHD8 and
- Douglas Yee, MD9
- 1Department of Nutrition, Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts;
- 2Diabetes Center of Excellence, UMass Memorial Medical Center and Departments of Medicine and Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts;
- 3Departments of Nutritional Sciences and Medical Biophysics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada;
- 4International Diabetes Center at Park Nicollet, Minneapolis, Minnesota;
- 5Epidemiology Research Program, American Cancer Society, Atlanta, Georgia;
- 6Division of Research, Kaiser Permanente, Oakland, California;
- 7Department of Oncology, McGill University, Montreal, Quebec, Canada;
- 8University of Colorado School of Medicine, Aurora, Colorado;
- 9Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota.
- Corresponding author: Edward Giovannucci, .
Diabetes and cancer are common diseases with tremendous impact on health worldwide. Epidemiologic evidence suggests that people with diabetes are at significantly higher risk for many forms of cancer. Type 2 diabetes and cancer share many risk factors, but potential biologic links between the two diseases are incompletely understood. Moreover, evidence from observational studies suggests that some medications used to treat hyperglycemia are associated with either increased or reduced risk of cancer. Against this backdrop, the American Diabetes Association and the American Cancer Society convened a consensus development conference in December 2009. Following a series of scientific presentations by experts in the field, the writing group independently developed this consensus report to address the following questions:
Is there a meaningful association between diabetes and cancer incidence or prognosis?
What risk factors are common to both diabetes and cancer?
What are possible biologic links between diabetes and cancer risk?
Do diabetes treatments influence risk of cancer or cancer prognosis?
For each area, the authors were asked to address the current gaps in evidence and potential research and epidemiologic strategies for developing more definitive evidence in the future. Table 1 includes a summary of findings and recommendations. Recommendations in this report are solely the opinions of the authors and do not represent official position of the American Diabetes Association or the American Cancer Society.
1. Is there a meaningful association between diabetes and cancer incidence or prognosis?
Both diabetes and cancer are prevalent diseases whose incidence is increasing globally. Worldwide, the prevalence of cancer has been difficult to establish because many areas do not have cancer registries, but in 2008 there were an estimated 12.4 million new cancer cases diagnosed. The most commonly diagnosed cancers are lung/bronchus, breast, and colorectal, whereas the most common causes of cancer deaths are lung, stomach, and liver cancer (1). In the U.S., the most commonly diagnosed …