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Epidemiology

Prevalent diabetes and risk of total, colorectal, prostate and breast cancers in an ageing population: meta-analysis of individual participant data from cohorts of the CHANCES consortium

British Journal of Cancer volume 124, pages 1882–1890 (2021)Cite this article

Subjects

Abstract

Background

We investigated whether associations between prevalent diabetes and cancer risk are pertinent to older adults and whether associations differ across subgroups of age, body weight status or levels of physical activity.

Methods

We harmonised data from seven prospective cohort studies of older individuals in Europe and the United States participating in the CHANCES consortium. Cox proportional hazard regression was used to estimate the associations of prevalent diabetes with cancer risk (all cancers combined, and for colorectum, prostate and breast). We calculated summary risk estimates across cohorts using pooled analysis and random-effects meta-analysis.

Results

A total of 667,916 individuals were included with an overall median (P25–P75) age at recruitment of 62.3 (57–67) years. During a median follow-up time of 10.5 years, 114,404 total cancer cases were ascertained. Diabetes was not associated with the risk of all cancers combined (hazard ratio (HR) = 0.94; 95% confidence interval (CI): 0.86–1.04; I2 = 63.3%). Diabetes was positively associated with colorectal cancer risk in men (HR = 1.17; 95% CI: 1.08–1.26; I2 = 0%) and a similar HR in women (1.13; 95% CI: 0.82–1.56; I2 = 46%), but with a confidence interval including the null. Diabetes was inversely associated with prostate cancer risk (HR = 0.81; 95% CI: 0.77–0.85; I2 = 0%), but not with postmenopausal breast cancer (HR = 0.96; 95% CI: 0.89–1.03; I2 = 0%). In exploratory subgroup analyses, diabetes was inversely associated with prostate cancer risk only in men with overweight or obesity.

Conclusions

Prevalent diabetes was positively associated with colorectal cancer risk and inversely associated with prostate cancer risk in older Europeans and Americans.

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Fig. 1: Random-effects meta-analysis of the association between diabetes and total cancer risk.
Fig. 2: Random-effects meta-analysis of the association between diabetes and colorectal cancer risk.
Fig. 3: Random-effects meta-analysis of the association between diabetes and prostate cancer risk.

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Acknowledgements

Where authors are identified as personnel of the International Agency for Research on Cancer/World Health Organization, the authors alone are responsible for the views expressed in this paper and they do not necessarily represent the decisions, policy or views of the International Agency for Research on Cancer/World Health Organization.

Author information

Authors and Affiliations

  1. International Agency for Research on Cancer (IARC/WHO), Nutrition and Metabolism Branch, Lyon, France

    Amina Amadou, Heinz Freisling, Mazda Jenab & Isabelle Romieu

  2. Department of Prevention Cancer Environment, Centre Léon Bérard, Lyon, France

    Amina Amadou

  3. Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece

    Konstantinos K. Tsilidis

  4. Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK

    Konstantinos K. Tsilidis

  5. Hellenic Health Foundation, Athens, Greece

    Antonia Trichopoulou

  6. Stony Brook Cancer Center, Stony Brook University, Stony Brook, NY, USA

    Paolo Boffetta

  7. Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy

    Paolo Boffetta

  8. Department of Radiation Sciences, Oncology Umeå University, Umeå, Sweden

    Bethany Van Guelpen

  9. Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden

    Bethany Van Guelpen

  10. Public Health Division of Gipuzkoa, BioDonostia Research Institute, San Sebastian, Spain

    Olatz Mokoroa

  11. Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway

    Tom Wilsgaard

  12. Institute for Health Sciences Risk and Inequality, Centre for Public Health, Belfast, UK

    Frank Kee

  13. Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany

    Ben Schöttker & Hermann Brenner

  14. Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Woodstock Road, Oxford, UK

    José M. Ordóñez-Mena

  15. NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK

    José M. Ordóñez-Mena

  16. Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland

    Satu Männistö & Kari Kuulasmaa

  17. Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden

    Stefan Söderberg

  18. Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands

    Roel C. H. Vermeulen

  19. Public Health Directorate, Asturias, Spain

    J. Ramón Quirós

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

    Linda M. Liao & Rashmi Sinha

  21. Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany

    Hermann Brenner

  22. German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany

    Hermann Brenner

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  1. Amina Amadou
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  2. Heinz Freisling
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Contributions

A.A., H.F., M.J. and I.R. conceived and designed the work. A.A. performed data analysis. I.R. and H.F. contributed to data analysis. K.K.T., A.T., P.B., B.V.G., O.M., T.W., F.K., B.S., J.M.O.M., S.M., S.S., R.C.H.V., J.R.Q., L.M.M., R.S., K.K. and H.B. acquired the data, and all authors played an important role in interpreting the results. A.A., H.F., M.J. and I.R. drafted the paper. K.K.T., A.T., P.B., B.V.G., O.M., T.W., F.K., B.S., J.M.O.M., S.M., S.S., R.C.H.V., J.R.Q., L.M.M., R.S., K.K. and H.B. revised the paper. All authors approved the final version of the paper and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. H.F. had full access to the data in the study and final responsibility for the decision to submit for publication.

Corresponding author

Correspondence to Heinz Freisling.

Ethics declarations

Ethics approval and consent to participate

All studies participating in CHANCES were conducted in accordance with the Declaration of Helsinki. For each study, investigators satisfied the local requirements for ethical research, including obtaining informed consent from participants.

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Not applicable.

Data availability

The CHANCES participating cohorts’ data are available only to the collaborating scientists from the respective CHANCES participating centres. The data may be available upon request for some of the participating centres but not for all due to relevant data protection laws.

Competing interests

The authors declare no competing interests.

Funding information

Data used throughout the present study are derived from the CHANCES project. The project is coordinated by the Hellenic Health Foundation, Greece. The project received funding by the FP7 framework programme of DG-RESEARCH in the European Commission (grant agreement no. HEALTH-F3-2010-242244). EPIC Greece: funded by the Hellenic Health Foundation. EPIC Netherlands: funded by European Commission (DG SANCO), Dutch Ministry of Public Health, Welfare and Sports (VWS), The National Institute for Public Health and the Environment, the Dutch Cancer Society, the Netherlands Organisation for Health Research and Development (ZONMW) and World Cancer Research Fund (WCRF). EPIC Spain: supported by Health Research Fund (FIS) of the Spanish Ministry of Health RTICC ‘Red Temática de Investigación Cooperativa en Cáncer (grant numbers: Rd06/0020/0091 and Rd12/0036/0018), Regional Governments of Andalucía, Asturias, Basque Country, Murcia (project 6236) and Navarra, Instituto de Salud Carlos III, Redes de Investigacion Cooperativa (RD06/0020). EPIC Umea: funded by Region Västerbotten and the Swedish Research Council. ESTHER: funded by the Baden-Württemberg State Ministry of Science, Research and Arts (Stuttgart, Germany), the Federal Ministry of Education and Research (Berlin, Germany) and the Federal Ministry of Family Affairs, Senior Citizens, Women and Youth (Berlin, Germany). Data from FINRISK, Belfast and Northern Sweden were harmonised for this analysis in the MOnica Risk, Genetics, Archiving and Monograph (MORGAM) Project. The activities of the MORGAM Data Centre have been sustained also by recent funding from European Union FP7 project BiomarCaRE (HEALTH-F2-2011-278913). PRIME Belfast: supported by grants from the Institut National de la Santé et de la Recherche Médicale (INSERM), the Merck, Sharp & Dohme-Chibret Laboratory and the Northern Ireland Health & Social Care Research and Development Office. Northern Sweden MONICA Study: funded by Umeå University and the county councils of Norr and Västertbotten. Tromsø: funded by UiT The Arctic University of Norway, the National Screening Service and the Research Council of Norway. This study was in part funded by the World Cancer Research Fund (WCRF UK) as part of the World Cancer Research Fund International grant programme (IIG_2019_1978, Principal Investigator, Heinz Freisling).

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Amadou, A., Freisling, H., Jenab, M. et al. Prevalent diabetes and risk of total, colorectal, prostate and breast cancers in an ageing population: meta-analysis of individual participant data from cohorts of the CHANCES consortium. Br J Cancer 124, 1882–1890 (2021). https://doi.org/10.1038/s41416-021-01347-4

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