Kirstin M J De Bruijn1, Rikje Ruiter2, Catherine E de Keyser3, Albert Hofman4, Bruno H Stricker5, Casper H J van Eijck6. 1. Department of Surgery, Erasmus Medical Center, Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands. Electronic address: k.debruijn@erasmusmc.nl. 2. Department of Epidemiology, Erasmus Medical Center, Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands. Electronic address: r.ruiter@erasmusmc.nl. 3. Department of Epidemiology, Erasmus Medical Center, Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands; The Health Care Inspectorate, The Hague, The Netherlands. Electronic address: c.dekeyser@erasmusmc.nl. 4. Department of Epidemiology, Erasmus Medical Center, Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands. Electronic address: a.hofman@erasmusmc.nl. 5. Department of Epidemiology, Erasmus Medical Center, Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands; The Health Care Inspectorate, The Hague, The Netherlands. Electronic address: b.stricker@erasmusmc.nl. 6. Department of Surgery, Erasmus Medical Center, Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands. Electronic address: c.vaneijck@erasmusmc.nl.
Abstract
AIM: Type 2 diabetes is associated with an increased cancer risk. Most studies on this topic analyse diabetes as a risk factor without adjusting for diabetes duration before cancer occurrence. This study aimed to investigate the association between diabetes duration and cancer risk in more detail. METHODS: In this prospective cohort study, diabetes diagnosis was based on clinical information and use of glucose lowering medication. Details on incident cancers were obtained via general practitioners and linkage to pathology registers. Cox proportional hazards models were used with onset and duration of diabetes as time-varying determinants. RESULTS: The study comprised 10,181 individuals. Diabetes was associated with an increased overall risk of incident cancers (hazard ratio (HR) 1.2, 95% confidence interval (CI) 1.07-1.39) and pancreatic cancer (HR 2.9, 95% CI 1.75-4.89). A diagnosis of diabetes less than three months before the diagnosis of cancer was associated with strongly increased risks of all- (HR 3.3, 95% CI 2.50-4.32) and pancreatic cancers (HR 28.7, 95% CI 6.32-130.58). CONCLUSION: The magnitude of the association between diabetes and an increased risk of cancer seems to be inflated by detection- or protopathic bias. Future studies investigating this association should adjust for diabetes duration and include a plausible aetiological risk window.
AIM: Type 2 diabetes is associated with an increased cancer risk. Most studies on this topic analyse diabetes as a risk factor without adjusting for diabetes duration before cancer occurrence. This study aimed to investigate the association between diabetes duration and cancer risk in more detail. METHODS: In this prospective cohort study, diabetes diagnosis was based on clinical information and use of glucose lowering medication. Details on incident cancers were obtained via general practitioners and linkage to pathology registers. Cox proportional hazards models were used with onset and duration of diabetes as time-varying determinants. RESULTS: The study comprised 10,181 individuals. Diabetes was associated with an increased overall risk of incident cancers (hazard ratio (HR) 1.2, 95% confidence interval (CI) 1.07-1.39) and pancreatic cancer (HR 2.9, 95% CI 1.75-4.89). A diagnosis of diabetes less than three months before the diagnosis of cancer was associated with strongly increased risks of all- (HR 3.3, 95% CI 2.50-4.32) and pancreatic cancers (HR 28.7, 95% CI 6.32-130.58). CONCLUSION: The magnitude of the association between diabetes and an increased risk of cancer seems to be inflated by detection- or protopathic bias. Future studies investigating this association should adjust for diabetes duration and include a plausible aetiological risk window.
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Authors: Isabel Prieto; Laura Del Puerto-Nevado; Nieves Gonzalez; Sergio Portal-Nuñez; Sandra Zazo; Marta Corton; Pablo Minguez; Carmen Gomez-Guerrero; Jose Miguel Arce; Ana Belen Sanz; Sebastian Mas; Oscar Aguilera; Gloria Alvarez-Llamas; Pedro Esbrit; Alberto Ortiz; Carmen Ayuso; Jesus Egido; Federico Rojo; Jesus Garcia-Foncillas Journal: PLoS One Date: 2017-03-02 Impact factor: 3.240
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