People with Type 2 Diabetes at Greater Risk of Having Advanced Stage Cancer at Time of Diagnosis

Anna Jansana, RN, MPH

An analysis of more than 11,000 people from half a dozen countries in Europe suggests people with type 2 diabetes were more likely to be diagnosed with some forms of advanced stage cancer than their counterparts without type 2 diabetes.

Using data from the European Prospective Investigation into Cancer and Nutrition (EPIC) study, a team of investigators from the International Agency for Research on Cancer (IARC) found individuals with preexisting type 2 diabetes were at an increased risk of advanced tumor stage at diagnosis for unscreened cancers, but investigators noted this was not seen for screened cancers such as breast and colorectal cancers.

“Our results underline the importance of paying particular attention to patients with pre-existing diseases of the heart, blood vessels or metabolism, such as type 2 diabetes, so that signs of cancer can be identified at an earlier stage when it is more likely to be treated successfully,” said lead investigator Anna Jansana, RN, MPH, a postdoctoral researcher at the Nutrition and Cancer Multimorbidity group at the IARC in Lyon, France, who presented the data at the European Breast Cancer Conference, in a statement.

Citing a lack of evidence on the subject, the current research effort was conducted by Janna and colleagues with an interest in assessing whether people with cardiometabolic diseases were at an increased risk of having cancer diagnosed at a more advanced stage. To do so, investigators designed their study as an analysis of patients diagnosed with cancer from within the EPIC study, which collected data from 400,577 participants who were cancer-free at baseline between 1992-2012. Among this cohort, investigators identified 11,945 individuals with a cancer diagnosis during the aforementioned time period.

Investigators planned to use logistic regression to estimate odds ratio (OR) of diagnosis of metastatic cancer according to presence of preexisting cardiovascular disease, type 2 diabetes, both, or no cardiometabolic disease among this cohort. For the purpose of analysis, investigators assessed cancers as all cancers combined and separately for screened cancers, which included breast and colorectal cancer, and nonscreened cancers, which was defined as all other cancers except breast and colorectal cancer. Investigators pointed out these analyses would be adjusted for country, age at cancer diagnosis, sex, physical activity, BMI, alcohol intake, smoking status, education level, and self-reported hypertension at baseline.

Of the 11,945 individuals identified for inclusion, 86.8% had no preexisting cardiometabolic disease at cancer diagnosis. Among those with preexisting cardiometabolic disease, 4.8% had a history of cardiovascular disease, 7.1% had a diagnosis of type 2 diabetes, and 1.3% had both.

Upon analysis, results indicated the ORs for metastatic compared with localized cancer for individuals with type 2 diabetes, cardiovascular and both compared to those without a cardiometabolic disease prior to cancer were 1.12 (95% CI, 0.95-1.30), 1.02 (95% CI, 0.79-1.16), and 1.11 (95% CI, 0.78-1.58), respectively. Further analysis revealed ORs for nonscreened cancers were 1.26 (95% CI, 1.04-1.55), 1.07 (95% CI 0.85-1.34), and 1.18 (95% CI 0.78-1.78), respectively, for those with type 2 diabetes, cardiovascular disease, and both prior to cancer diagnosis, with no associations observed for screened cancers.

“The good news is that for patients with breast or colorectal cancer, the national screening programmes seem to be detecting cancer often before it has started to spread, both for those with and without pre-existing diagnoses of cardiovascular disease and type 2 diabetes. Our findings underline the importance of participating in screening when invited,” Jansana added. “However, for cancers for which there are no national screening programmes, our results may prompt policymakers to broaden the scope of public health recommendations to encompass patients affected by cardiometabolic diseases and cancer.”

This study, “Impact of pre-existing cardiometabolic diseases on cancer stage at diagnosis in the EPIC study,” was presented at the European Breast Cancer Conference.