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Is diabetes mellitus an independent risk factor for colon cancer and rectal cancer?

Abstract

OBJECTIVES

Diabetes mellitus (DM) has been associated with an increased risk of colorectal cancer (CRC). The American College of Gastroenterology Guidelines for Colorectal Cancer Screening 2008 recommend that clinicians be aware of an increased CRC risk in patients with smoking and obesity, but do not highlight the increase in CRC risk in patients with DM. To provide an updated quantitative assessment of the association of DM with colon cancer (CC) and rectal cancer (RC), we conducted a meta-analysis of case-control and cohort studies. We also evaluated whether the association varied by sex, and assessed potential confounders including obesity, smoking, and exercise.

METHODS

We identified studies by searching the EMBASE and MEDLINE databases (from inception through 31 December 2009) and by searching bibliographies of relevant articles. Summary relative risks (RRs) with 95% confidence intervals (CIs) were calculated with fixed- and random-effects models. Several subgroup analyses were performed to explore potential study heterogeneity and bias.

RESULTS

DM was associated with an increased risk of CC (summary RR 1.38, 95% CI 1.26-1.51; n=14 studies) and RC (summary RR 1.20, 95% CI 1.09-1.31; n=12 studies). The association remained when we limited the meta-analysis to studies that either controlled for smoking and obesity, or for smoking, obesity, and physical exercise. DM was associated with an increased risk of CC for both men (summary RR 1.43, 95% CI 1.30-1.57; n=11 studies) and women (summary RR 1.35, 95% CI 1.14-1.53; n=10 studies). For RC, there was a significant association between DM and cancer risk for men (summary RR 1.22, 95% CI 1.07-1.40; n=8 studies), but not for women (summary RR 1.09, 95% CI=0.99-1.19; n=8 studies).

CONCLUSIONS

These data suggest that DM is an independent risk factor for colon and rectal cancer. Although these findings are based on observational epidemiological studies that have inherent limitations due to diagnostic bias and confounding, subgroup analyses confirmed the consistency of our findings across study type and population. This information can inform risk models and specialty society CRC screening guidelines.

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  • Authors+Show Affiliations

    ,

    Division of Epidemiology, Berkeley School of Public Health, University of California, Berkeley, California 94720-7358, USA. hirokiyuhara@gmail.com

    , , , ,

    Source

    The American journal of gastroenterology 106:11 2011 Nov pg 1911-21; quiz 1922

    MeSH

    Body Mass Index
    Case-Control Studies
    Cohort Studies
    Colonic Neoplasms
    Confidence Intervals
    Diabetes Mellitus, Type 1
    Diabetes Mellitus, Type 2
    Exercise
    Female
    Humans
    Male
    Obesity
    Rectal Neoplasms
    Risk Assessment
    Smoking

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Review

    Language

    eng

    PubMed ID

    21912438

    Citation

    Yuhara, Hiroki, et al. "Is Diabetes Mellitus an Independent Risk Factor for Colon Cancer and Rectal Cancer?" The American Journal of Gastroenterology, vol. 106, no. 11, 2011, pp. 1911-21; quiz 1922.
    Yuhara H, Steinmaus C, Cohen SE, et al. Is diabetes mellitus an independent risk factor for colon cancer and rectal cancer? Am J Gastroenterol. 2011;106(11):1911-21; quiz 1922.
    Yuhara, H., Steinmaus, C., Cohen, S. E., Corley, D. A., Tei, Y., & Buffler, P. A. (2011). Is diabetes mellitus an independent risk factor for colon cancer and rectal cancer? The American Journal of Gastroenterology, 106(11), pp. 1911-21; quiz 1922. doi:10.1038/ajg.2011.301.
    Yuhara H, et al. Is Diabetes Mellitus an Independent Risk Factor for Colon Cancer and Rectal Cancer. Am J Gastroenterol. 2011;106(11):1911-21; quiz 1922. PubMed PMID: 21912438.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Is diabetes mellitus an independent risk factor for colon cancer and rectal cancer? AU - Yuhara,Hiroki, AU - Steinmaus,Craig, AU - Cohen,Stephanie E, AU - Corley,Douglas A, AU - Tei,Yoshihiro, AU - Buffler,Patricia A, Y1 - 2011/09/13/ PY - 2011/9/14/entrez PY - 2011/9/14/pubmed PY - 2012/1/4/medline SP - 1911-21; quiz 1922 JF - The American journal of gastroenterology JO - Am. J. Gastroenterol. VL - 106 IS - 11 N2 - OBJECTIVES: Diabetes mellitus (DM) has been associated with an increased risk of colorectal cancer (CRC). The American College of Gastroenterology Guidelines for Colorectal Cancer Screening 2008 recommend that clinicians be aware of an increased CRC risk in patients with smoking and obesity, but do not highlight the increase in CRC risk in patients with DM. To provide an updated quantitative assessment of the association of DM with colon cancer (CC) and rectal cancer (RC), we conducted a meta-analysis of case-control and cohort studies. We also evaluated whether the association varied by sex, and assessed potential confounders including obesity, smoking, and exercise. METHODS: We identified studies by searching the EMBASE and MEDLINE databases (from inception through 31 December 2009) and by searching bibliographies of relevant articles. Summary relative risks (RRs) with 95% confidence intervals (CIs) were calculated with fixed- and random-effects models. Several subgroup analyses were performed to explore potential study heterogeneity and bias. RESULTS: DM was associated with an increased risk of CC (summary RR 1.38, 95% CI 1.26-1.51; n=14 studies) and RC (summary RR 1.20, 95% CI 1.09-1.31; n=12 studies). The association remained when we limited the meta-analysis to studies that either controlled for smoking and obesity, or for smoking, obesity, and physical exercise. DM was associated with an increased risk of CC for both men (summary RR 1.43, 95% CI 1.30-1.57; n=11 studies) and women (summary RR 1.35, 95% CI 1.14-1.53; n=10 studies). For RC, there was a significant association between DM and cancer risk for men (summary RR 1.22, 95% CI 1.07-1.40; n=8 studies), but not for women (summary RR 1.09, 95% CI=0.99-1.19; n=8 studies). CONCLUSIONS: These data suggest that DM is an independent risk factor for colon and rectal cancer. Although these findings are based on observational epidemiological studies that have inherent limitations due to diagnostic bias and confounding, subgroup analyses confirmed the consistency of our findings across study type and population. This information can inform risk models and specialty society CRC screening guidelines. SN - 1572-0241 UR - https://www.unboundmedicine.com/medline/citation/21912438/full_citation L2 - http://Insights.ovid.com/pubmed?pmid=21912438 DB - PRIME DP - Unbound Medicine ER -