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Diabetes and risk of incident colorectal cancer in a prospective cohort of women

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Abstract

Objective

To determine whether accounting for the time dynamics of diabetes exposure will change the risk estimates for colorectal cancer.

Methods

We analyzed data from the 45, 516 women enrolled in the BCDDP follow-up cohort study. We used proportional hazards regression to obtain multivariable-adjusted risk estimates for incident colorectal cancer for prevalent diabetes at baseline and diabetes as a time-dependent variable.

Results

Subjects with diabetes had a statistically significant increased risk of colorectal cancer compared to subjects without diabetes (RR = 1.60, 95% CI 1.18–2.18). When we defined exposure as duration of diabetes exposure at cohort exit, we found that in the first 4 years after diagnosis risk was essentially the same as in those never having had a diagnosis of diabetes. For those who had been diagnosed between 4 and 8 years previously, however, we observed a RR of 2.36 (95% CI 0.96–5.79), while longer duration of exposure was associated with smaller and then no change in risk compared to those without a diagnosis of diabetes.

Conclusions

These results are consistent with the theory that hyperinsulinemia can explain, at least in part, the association of diabetes with colorectal cancer, but in a time-dependent manner.

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Acknowledgments

The authors would like to thank Leslie Carroll at IMS, Inc., Silver Spring, MD for computer support and Cathy Ann Grundmayer, Susan Englehart, and the BCDDP staff of Westat, Inc., Rockville, MD for assistance in collecting and processing data for the study. The authors wish to acknowledge the California Department of Health Services, Cancer Surveillance Section; the Florida Cancer Data System under contract to the state Department of Health; the Maryland Cancer Registry, Maryland Department of Health and Mental Hygiene; the Michigan Cancer Surveillance Program within the Division for Vital Records and Health Statistics, Michigan Department of Community Health; the Division of Health Statistics, Pennsylvania Department of Health; the Tennessee Cancer Registry; the Texas Department of Health; and the states of Arizona, Georgia, Hawaii, Idaho, Iowa, New Jersey, New York, North Carolina, Ohio, Oregon, and Rhode Island for providing data from their cancer registries for use in these analyses.

Financial support

Funding for this work was provided by National Institutes of Health (K07 CA108910-01A1 to A.F.) and Intramural Research Program funds from the National Cancer Institute, Bethesda, MD.

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Authors and Affiliations

  1. Division of Epidemiology and Community Health, University of Minnesota, 1300 South Second Street, Suite 300, Minneapolis, MN, 55454, USA

    Andrew Flood & Lori Strayer

  2. The Masonic Cancer Center at the University of Minnesota, Minneapolis, MN, USA

    Andrew Flood

  3. Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA

    Catherine Schairer & Arthur Schatzkin

Authors
  1. Andrew Flood
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  2. Lori Strayer
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Correspondence to Andrew Flood.

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Flood, A., Strayer, L., Schairer, C. et al. Diabetes and risk of incident colorectal cancer in a prospective cohort of women. Cancer Causes Control 21, 1277–1284 (2010). https://doi.org/10.1007/s10552-010-9555-0

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  • DOI: https://doi.org/10.1007/s10552-010-9555-0

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