Duration of Diabetes and Pancreatic Cancer in a Case-Control Study in the Midwest and the Iowa Women’s Health Study (IWHS) Cohort

Sarah A Henry; Anna E Prizment; Kristin E Anderson

doi:10.6092/1590-8577/1317

Sarah A Henry Division of Epidemiology and Community Health, School of Public Health, University of Minnesota; University of Minnesota Masonic Cancer Center. Minneapolis, MN, USA
Anna E Prizment Division of Epidemiology and Community Health, School of Public Health, University of Minnesota; University of Minnesota Masonic Cancer Center. Minneapolis, MN, USA
Kristin E Anderson Division of Epidemiology and Community Health, School of Public Health, University of Minnesota; University of Minnesota Masonic Cancer Center. Minneapolis, MN, USA

DOI: https://doi.org/10.6092/1590-8577/1317

Keywords: Case-Control Studies, Cohort Studies, Diabetes Mellitus, Pancreatic Neoplasms

Abstract

Context Studies have shown a relationship between history of diabetes and the risk of pancreatic cancer; however, the temporal relation between diabetes and pancreatic cancer is not clearly established. Objectives Diabetes and diabetes duration were examined in relation to pancreatic cancer in a population-based case-control study and prospective cohort. Methods Case-control study: pancreatic cancer cases (n=200) from the Midwest were frequency matched by age and sex to population controls (n=673). Logistic regression yielded odds ratios (ORs) and 95% confidence intervals (95% CI). Iowa Women’s Health Study (IWHS) cohort: 292 incident pancreatic cancer cases occurred between 1986-2008 among 36,084 post-menopausal, initially cancer-free women. Diabetes status and diagnosis age were ascertained at baseline and follow-ups. Proportional hazards regression yielded hazard ratios (HR, 95% CI) for pancreatic cancer in relation to baseline diabetes. Time-dependent analyses accounted for diabetes diagnosed after baseline. A nested-case control analysis assessed diabetes duration as a risk factor. Results In the case-control study, compared to participants without diabetes, the multivariate ORs (95% CI) for pancreatic cancer were 2.35 (1.24-4.47) for those with diabetes and 4.00 (0.94-16.9), 2.79 (0.97-8.04), and 2.40 (0.97-5.98) for diabetes durations of 2-5 years, 5.1-10 years, and more than 10 years, respectively. In IWHS, compared to no diabetes, multivariate-adjusted HRs for pancreatic cancer were 1.86 (1.23-2.83) for baseline diabetes and 1.94 (1.40-2.69) adding diabetes during follow-up. In an IWHS nested case-control analysis, ORs were 1.70 (0.78-3.67), 2.62 (1.48-4.65), and 2.10 (1.36-3.24) for diabetes durations of 2-5 years, 5.1-10 years and more than 10 years, respectively, versus no diabetes. Conclusions Diabetes is associated with pancreatic cancer risk and this is similar across different duration categories.

Image: People (Division of Epidemiology and Community Health, University of Minnesota. Minneapolis, MN, USA).

Downloads

Download data is not yet available.

Author Biographies

Sarah A Henry, Division of Epidemiology and Community Health, School of Public Health, University of Minnesota; University of Minnesota Masonic Cancer Center. Minneapolis, MN, USA

Bureau of Women and children's Health

Division of Public Health and Prevention Services

Anna E Prizment, Division of Epidemiology and Community Health, School of Public Health, University of Minnesota; University of Minnesota Masonic Cancer Center. Minneapolis, MN, USA

Division of Epidemiology and Community Health

Kristin E Anderson, Division of Epidemiology and Community Health, School of Public Health, University of Minnesota; University of Minnesota Masonic Cancer Center. Minneapolis, MN, USA

Division of Epidemiology and Community Health

References

Bao B, Wang Z, Li Y, Kong D, Ali S, Banerjee S, et al. The complexities of obesity and diabetes with the development and progression of pancreatic cancer. Biochim et Biophys Acta. 2011; 1815:135-146.

Yalniz M, Pour PM. Diabetes mellitus: a risk factor for pancreatic cancer? Langenbecks Arch Surg. 2005; 390:66-72.

American Cancer Society. Cancer Facts & Figures 2013. Atlanta: American Cancer Society; 2013.

Ben Q, Cai Q, Li Z, Yuan Y, Ning X, Deng S, et al. The relationship between new-onset diabetes mellitus and pancreatic cancer risk: A case-control study. Eur J Cancer. 2011; 47:248-254.

Anderson LN, Cotterchio M, Gallinger S. Lifestyle, dietary, and medical history factors associated with pancreatic cancer risk in Ontario, Canada. Cancer Causes Control. 2009; 20:825-834.

Chan JM, Wang F, Holly EA. Sweets, sweetened beverages, and risk of pancreatic cancer in a large population-based case-control study. Cancer Causes Control. 2009; 20:835-846.

Huxley R, Ansary-Moghaddam A, Berrington de Gonzalez A, Barzi F, Woodward M. Type-II diabetes and pancreatic cancer: a meta-analysis of 36 studies. Br J Cancer. 2005; 92:2076-2083.

Silverman DT, Schiffman M, Everhart J, Goldstein A, Lillemoe KD, Swanson GM, et al. Diabetes mellitus, other medical conditions and familial history of cancer as risk factors for pancreatic cancer. Br J Cancer. 1999; 80:1830-1837.

Chow WH, Gridley G, Nyren O, Linet MS, Ekbom A, Fraumeni JF Jr, et al. Risk of pancreatic cancer following diabetes mellitus: a nationwide cohort study in Sweden. J Natl Cancer Inst. 1995; 87:930-931.

Lipworth L, Zucchetto A, Bosetti C, Franceschi S, Talamini R, Serraino D, et al. Diabetes mellitus, other medical conditions and pancreatic cancer: a case-control study. Diabetes Metab Res Rev. 2011; 27:255-261.

Zhang J, Dhakal IB, Gross MD, Lang N, Kadlubar FF, Harnack LJ, et al. Physical activity, diet, and pancreatic cancer: A population-based, case-control study in Minnesota. Nutr Cancer. 2009; 61:457-465.

Anderson KE, Sinha R, Kulldorff M, Gross M, Lang NP, Barber C, et al. Meat intake and cooking techniques: Associations with pancreatic cancer. Mutat Res. 2002; 506-507:225-231.

Chari ST, Leibson CL, Rabe KG, Timmons LJ, Ransom J, de Andrade M, et al. Pancreatic cancer-associated diabetes mellitus: prevalence and temporal association with diagnosis of cancer. Gastroenterology. 2008; 134:95-101.

Gullo L, Pezzilli R, Morselli-Labate AM. Italian Pancreatic Cancer Study Group. Diabetes and the risk of pancreatic cancer. N Engl J Med. 1994; 331:81-84.

Pannala R, Basu A, Petersen GM, Chari ST. New-onset diabetes: a potential clue to the early diagnosis of pancreatic cancer. Lancet Oncol. 2009; 10:88-95.

Folsom AR, Kaye SA, Prineas RJ, Potter JD, Gapstur SM, Wallace RB. Increased incidence of carcinoma of the breast associated with abdominal adiposity in postmenopausal women. Am J Epidemiol. 1990; 131:794–803.

Surveillance Epidemiology and End Results (SEER). ICD-O-3 SEER site/histology validation list. 2009. Available at: http://seer.cancer.gov/icd-o-3/sitetype.icdo3.d20091204.pdf. Accessed February 21 2011.

Prizment AE, Anderson KE, Hong CP, Folsom AR. Pancreatic cancer incidence in relation to female reproductive factors: Iowa Women’s Health Study. JOP. 2007; 8 :16-27.

World Cancer Research Fund (WCRF). Food, nutrition, and the prevention of cancer: a global perspective. Washington D.C.: World Cancer Research Fund/American Institute for Cancer Research; 1997.

Luo J, Iwasaki M, Inoue M, Sasazuki S, Otani T, Ye W, et al. Body Mass Index, physical activity, and the risk of pancreatic cancer in relation to smoking status and history of diabetes: a large scale population-based cohort study in Japan- The JPAC Study. Cancer Causes Control. 2007; 18:603-612.

Li D, Tang H, Hassan MM, Holly EA, Bracci PM, Silverman DT. Diabetes and risk of pancreatic cancer: a pooled analysis of three large case-control studies. Cancer Causes Control. 2011; 22:189-197.

Kushi LH, Kaye SA, Folsom AR, Soler JT, Prineas RJ. Accuracy and reliability of self-measurement of body girths. Am J Epidemiol. 1988; 128:740-748.

Martin LM, Leff M, Calonge N, Garrett C, Nelson DE. Validation of self-reported chronic conditions and health services in a managed care population. Am J Prev Med. 2000; 18:215-218.

Midthjell K, Holmen J, Bjorndal A, Lund-Larsen G. Is questionnaire information valid in the study of chronic disease such as diabetes? The Nord-Trondelag diabetes study. J Epidemiol Community Health. 1992; 46:537-542.

Simpson CF, Boyd CM, Carlson MC, Griswold ME, Guralnik JM, Fried LP. Agreement between self-report of disease diagnoses and medical record validation in disabled older women: factors that modify agreement. J Am Geriatr Soc. 2004; 52:123-127.

Kaye SA, Folsom AR, Sprafka JM, Prineas RJ, Wallace RB. Increased incidence of diabetes mellitus in relation to abdominal adiposity in older women. J Clin Epidemiol. 1991; 44:329-334.

Centers for Disease Control and Prevention (CDC). National diabetes fact sheet, 2011. 2011. Available at: http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf. Accessed May 25 2011.

Raimondi S, Maisonneuve P, Lowenfels AB. Epidemiology of pancreatic cancer: an overview. Nat Rev Gastroenterol Hepatol. 2009; 6:699-708.

Rutter WJ. The development of the endocrine and exocrine pancreas. In: Fitzgerald PJ, Morrison AB, eds. The Pancreas. Baltimore, MD: Liiencott Williams & Wilkins; 1980: 30-38.

Walker AM. Diabetes and pancreatic cancer. In: Zatonski W, Boyle P, Tyczynski J, eds. Warsaw, PA: Cancer Prevention, Vital Statistics to Intervention, Interpress;1990:152-154.

Johnson JA, Carstensen B, Witte D, Bowker SL, Lipscombe L, Renehan AG. Diabetes and cancer (1): evaluating the temporal relationship between type 2 diabetes and cancer incidence.[Review]. Diabetologia. 2012; 55:1607-1618.

Yachida S, Jones S, Bozic I, Antal T, Leary R, Fu B, et al. Distant metastasis occurs late during the genetic evolution of pancreatic cancer. Nature. 2010; 467: 1114-1117.