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Epidemiology

Type 2 diabetes and risk of colorectal cancer in two large U.S. prospective cohorts

British Journal of Cancer (2018) | Download Citation

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Abstract

Background

Previous studies have shown a positive association between type 2 diabetes (T2D) and colorectal cancer (CRC) risk. However, it is uncertain whether this association differs by duration of T2D or sex. We thus investigated the associations of T2D and its duration with the risk of incident CRC.

Methods

We followed 87,523 women from the Nurses’ Health Study (1980–2012) and 47,240 men from the Health Professionals Follow-up Study (1986–2012). Data on physician-diagnosed T2D was collected at baseline with a questionnaire and updated biennially. Cox regression models were used to estimate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs).

Results

We documented 3000 CRC cases during up to 32 years of follow-up. Among men, T2D was associated with increased risk of CRC compared to those without T2D (HR: 1.42; 95% CI: 1.12–1.81). This positive association persisted in sensitivity analyses by excluding CRC identified within 1 year of diabetes diagnosis and patients with T2D who used hypoglycaemic medications. Among women, T2D was positively, but not statistically significantly, associated with CRC risk (HR: 1.17; 95% CI: 0.98–1.39).

Conclusions

Our findings support that T2D was associated with a moderately higher risk of developing CRC in men; a weaker, nonsignificant positive association was observed in women.

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Additional information

Ethical approval/consent to participate: The study protocol was approved by the institutional review board of the Brigham and Women’s Hospital and the Human Subjects Committee Review Board of the Harvard T. H. Chan School of Public Health.

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Acknowledgements

We would like to thank the participants and staff of the Nurses’ Health Study and the Health Professionals Follow-up Study for their valuable contributions as well as the following state cancer registries for their help: A.L., A.Z., A.R., C.A., C.O., C.T., D.E., F.L., G.A., I.D., I.L., I.N., I.A., K.Y., L.A., M.E., M.D., M.A., M.I., N.E., N.H., N.J., N.Y., N.C., N.D., O.H., O.K., O.R., P.A., R.I., S.C., T.N., T.X., V.A., W.A., W.Y.

Author information

Affiliations

  1. School of Public Health, China Medical University, Shenyang, Liaoning, P.R. China

    • Yanan Ma
    •  & Deliang Wen
  2. Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

    • Yanan Ma
    • , Wanshui Yang
    • , Frank B. Hu
    • , Andrew T. Chan
    • , Edward L. Giovannucci
    •  & Xuehong Zhang
  3. Department of Nutrition, School of Public Health, Anhui Medical University, Hefei, Anhui, P.R. China

    • Wanshui Yang
  4. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    • Mingyang Song
    • , Stephanie A. Smith-Warner
    • , Yanping Li
    • , Yang Hu
    • , Frank B. Hu
    •  & Edward L. Giovannucci
  5. Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

    • Mingyang Song
    •  & Andrew T. Chan
  6. Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA

    • Mingyang Song
    •  & Andrew T. Chan
  7. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    • Stephanie A. Smith-Warner
    •  & Yang Hu
  8. 2011 Collaborative Innovation Center of Tianjin for Medical Epigenetics, Key Laboratory of Hormone and Development (Ministry of Health), Metabolic Disease Hospital and Tianjin Institute of Endocrinology, Tianjin Medical University, 300070, Tianjin, P.R. China

    • Juhong Yang
  9. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    • Wenjie Ma
    • , Shuji Ogino
    •  & Edward L. Giovannucci
  10. Department of Oncologic Pathology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA

    • Shuji Ogino
  11. Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA

    • Shuji Ogino
    •  & Andrew T. Chan
  12. Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

    • Shuji Ogino
  13. Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    • Andrew T. Chan

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Contributions

Y.M. wrote the paper. Y.M. and W.Y. did the statistical analysis, supervised by X.Z. All authors contributed to the data interpretation, revised each draft for important intellectual content, and read and approved the final manuscript.

Competing interests

The authors declare no competing interests.

Availability of data and materials

The data sets generated during and/or analysed during the current study are available for non-commercial use from the corresponding author on reasonable request.

Ethical approval/consent to participate

The study protocol was approved by the institutional review board of the Brigham and Women’s Hospital and the Human Subjects Committee Review Board of the Harvard T. H. Chan School of Public Health.

Funding

No external funding was used for conducting this study.

Note

This work is published under the standard license to publish agreement. After 12 months the work will become freely available and the license terms will switch to a Creative Commons Attribution 4.0 International (CC BY 4.0).

Corresponding author

Correspondence to Xuehong Zhang.

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DOI

https://doi.org/10.1038/s41416-018-0314-4