| Abstract |
Background: The prevalence of obesity and diabetes are increasing worldwide. The metabolic abnormalities associated with obesity and diabetes have the potential to significantly contribute to the development and progression of cancer. Evidence suggests that obesity and diabetes are associated with an increased risk of several types of cancers and poorer prognosis of cancer outcomes.
Purpose: This study aims to evaluate the association of obesity and type II diabetes with cancer incidence, mortality and survival in Crete.
Methods: The present study consist a real-world data mining study. Data were obtained from the Cancer Registry of Crete which is the only population-based registry in Greece since 1992. Data were coded according to the ICD-10O and included several parameters on demographics, medical history, and lifestyle factors. A cohort study was conducted involving 49.256 registered subjects which had been diagnosed with any type of malignant neoplasm between the time period of 1992-2021. Age-standardized incidence rates (Age-Standardized Incidence Rates-ASIR/100,000/year and Age-Standardized Mortality Rates-ASMR/100,000/year) were estimated. Z score and Mann-Whitney tests were applied for comparisons between indicators. Finally, several multivariate logistic regression models were created to estimate relative risk (RR) and control for determinants of incidence, focusing on the role of BMI and the presence of type 2 diabetes. In addition, the Annual Percentage Change (APC %) for the change in relative incidence risk by type of malignancy was estimated. APC% was evaluated through P Value for trend, through a Bayesian longitudinal model. Finally, a Cox Regression was applied to estimate the Hazard Risk of low cancer survival, taking into account BMI and the presence of type 2 diabetes.
Results: For the period 19922–2021, ASIRs ranged from 41.2 to 7.2 new cases/100,000 population for lung and bronchus and kidney malignancies, respectively. Regarding mortality, the ASMRs were from 37.6 to 4.1 deaths/100,000 population for lung and bronchus and ovarian malignancies, respectively. Estimated prevalent cases of obesity and diabetes in our sample were 29% and 8%, respectively. Obesity was associated with an increased overall cancer risk (RR:2.1;95%CI:1.7-2.5). Obese subjects had a 2.3-4.3-fold higher risk of developing breast, colorectal, endometrial, esophageal, renal, pancreatic and liver cancer compared to non-obese. Type 2 diabetes was not statistically significant associated with an increased overall cancer risk. Diabetic patients had a 2.6-3.2-fold higher risk of developing renal, colorectal, breast, pancreatic and liver cancer compared to non-diabetic patients. A time trend analysis revealed that obesity was associated with a 0.2%, 1.2% and 1.6% annual increase in relative risks of liver, endometrial and breast cancer, respectively. Type 2 diabetes was also associated with a 1.2% annual increase in relative risk of breast cancer. Regarding survival from cancer, obesity and type 2 diabetes were associated with an increased risk of overall poor survival from cancer. Obese cancer patients had a 2.4-4.8-fold higher risk of poor survival from liver, renal, esophageal, pancreatic, endometrial, colorectal and breast cancer compared to non-obese. Additionally, diabetic cancer patients had a 2.3-3.8-fold higher risk of poor survival from breast, colorectal, renal, pancreatic and liver cancer compared to non-diabetic.
Conclusion: Obesity and type 2 diabetes increases the risk of developing or dying from some malignant neoplasms. These findings suggest that health interventions regarding obesity should be involved not only in cancer prevention programs but also in cancer care. Additionally, these findings open the dialogue for common diabetes and cancer screening programs and better health care choices regarding medication of diabetes and glycemic control in cancer patients.
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