Cancer and diabetes co-occurrence: A national study with 44 million person-years of follow-up

Abstract

The number of new cases of cancer is increasing each year, and rates of diabetes mellitus are also increasing dramatically over time. It is not an unusual occurrence for an individual to have both cancer and diabetes at the same time, given they are both individually common, and that one condition can increase the risk of the other. In this manuscript, we use national-level diabetes (Virtual Diabetes Register) and cancer (New Zealand Cancer Registry) data on nearly five million individuals over 44 million person-years of follow-up to examine the occurrence of cancer amongst a national prevalent cohort of patients with diabetes. We completed this analysis separately by cancer for the 24 most commonly diagnosed cancers in Aotearoa New Zealand, and then compared the occurrence of cancer among those with diabetes to those without diabetes. We found that the rate of cancer was highest amongst those with diabetes for 21 of the 24 most common cancers diagnosed over our study period, with excess risk among those with diabetes ranging between 11% (non-Hodgkin's lymphoma) and 236% (liver cancer). The cancers with the greatest difference in incidence between those with diabetes and those without diabetes tended to be within the endocrine or gastrointestinal system, and/or had a strong relationship with obesity. However, in an absolute sense, due to the volume of breast, colorectal and lung cancers, prevention of the more modest excess cancer risk among those with diabetes (16%, 22% and 48%, respectively) would lead to a substantial overall reduction in the total burden of cancer in the population. Our findings reinforce the fact that diabetes prevention activities are also cancer prevention activities, and must therefore be prioritised and resourced in tandem.

Fig 1. Age–standardised rates (ASR, 95% confidence intervals) of cancer amongst those with and without diabetes, for the 24 most commonly diagnosed cancers in Aotearoa New Zealand.

Fig 2. Age–standardised rate ratios (RR) of cancer between those with diabetes compared to those without diabetes (reference group), for the 24 most commonly diagnosed cancers in Aotearoa New Zealand.

Fig 3

Age–standardised rates (ASR) of the top–10 cancers diagnosed among females (top) with diabetes and males (bottom) with diabetes, alongside data for those without diabetes.

Fig 4

Age–standardised rate ratio (RR) of cancer between those with diabetes compared to those without diabetes (reference group), separately for the top–10 largest disparities for females (top) and males (bottom).