Type 2 diabetes, adiposity and cancer morbidity and mortality risk taking into account competing risk of noncancer deaths in a prospective cohort setting

Abstract

Type 2 diabetes (T2D) and adiposity associate with increased risk of several cancers, but the impact of competing risk of noncancer deaths on these associations is not known. We prospectively examined participants in the Malmö Diet and Cancer Study aged 44–73 years with no history of cancer at baseline (n = 26,953, 43% men). T2D was ascertained at baseline and during follow‐up, and body mass index (BMI) and waist circumference (WC) at baseline. Multivariable cause‐specific hazard ratios (HR) and subdistribution hazard ratios (sHR), taking into account noncancer deaths, were estimated using Cox‐ and competing risk regression. During follow‐up (mean 17 years), 7,061 incident cancers (3,220 obesity‐related cancer types) and 2,848 cancer deaths occurred. BMI and WC were associated with increased risk of obesity‐related cancer incidence and cancer mortality. In T2D subjects, risk of obesity‐related cancer was elevated among men (HR = 1.31, 95% CI: 1.12–1.54; sHR = 1.29, 95% CI: 1.10–1.52), and cancer mortality among both men and women (HR = 1.34, 95% CI: 1.20–1.49; sHR = 1.30, 95% CI: 1.16–1.45). There was no elevated actual risk of cancer death in T2D patients with long disease duration (sHR = 1.00, 95% CI: 0.83–1.20). There was a significant additive effect of T2D and adiposity on risk of obesity‐related cancer and cancer mortality. In conclusion, detection bias may partially explain the increased risk of cancer morbidity among T2D patients. Both excess risk of competing events among patients with T2D and depletion of susceptibles due to earlier cancer detection will lower the actual risk of cancer, particularly with longer diabetes duration and at older ages.

Have incidence rates of liver cancer peaked in the United States?

“…Herein, we have demonstrated that HCC rates have not only plateaued but have significantly declined between 2011 and 2016. Although to our knowledge the reasons for the decline in HCC rates are not clear, factors that may have had an effect include halting the spread of hepatitis C virus (HCV) via testing of the blood supply, improvements in HCV treatment, and competing mortality risks . However, of these potential factors, it should be noted that direct‐acting antiviral (DAA) therapy for HCV was not approved by the US Food and Drug Administration until 2011 and the all‐oral DAA combinations were not available until 2014 .…”

Body mass index and cancer risk in patients with type 2 diabetes: a dose–response meta-analysis of cohort studies

“…Studies were excluded if they had retrospective case–control or cross-sectional design. In case of studies that did not provide sufficient information to calculate effect sizes, corresponding authors were contacted, and of those, two studies provided additional data from their studies 33 , 34 . Two authors (SS and Sh A) independently screened the title and abstract of all articles retrieved.…”

Evaluation of the hypoglycemic effect of seven wild folkloric edible plants from Palestine

“…Its increased morbidity and mortality rates all over the world decrease the quality of human being's lives and productivity even in the developed countries. As a result, it is considered one of the challenging diseases in the pharmaceutical world [4,5]. Currently, available therapeutic agents for DM include insulin and various oral antidiabetic drugs such as glinides, sulfonylureas, and biguanides; most of them have a number of harmful side effects; for this reason, the investigations of safer and effective hypoglycemic medications is one of the essential areas of research [6].…”