Colorectal Cancer & Diabetes

Colorectal Cancer Advisory Committee

June 21, 2006

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 Objectives:
Review of evidence related to association between
diabetes and colorectal cancer

Discussion of committees position and message to:

o Providers
o Public

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 The Burden of Colorectal Cancer
Nearly 2/3 of CRC cases are diagnosed at an advanced
stage.

In Michigan during 2001: Only 39% of new diagnoses

were at the localized stage

Cancers that can be detected by screening account for

one half of all new cancer cases.1

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 The Burden of Diabetes
An estimated 18.2 million Americans had diabetes in 2002.2

From 1990 to 2001, the prevalence of diabetes increased by 61%,

with about 1.3 million Americans being diagnosed each year. 30

Type II diabetes accounts for 90% to 95% of all diagnosed cases.3

It has been estimated that 70% of type II diabetes in the U.S. is

attributable to overweight and obesity.4

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 Risk Factors for Colorectal Cancer
Several studies observed a positive association between fasting
and non-fasting glucose levels and CRC incidence and
mortality. 16,17,25, 28

Epidemiologic and animal studies have shown that overweight

and obesity are associated with increased risk for cancers at
numerous sites, including breast (among postmenopausal
women) and colon.7,8,9,10

Physical activity causes food to move more quickly through

the intestine, reducing the length of time that the bowel lining is
exposed to potential mutagens.13
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 Diabetes & Colorectal Cancer
Dietary and lifestyle factors related to insulin resistance and
hyperinsulinemia have been linked to increased colorectal cancer
risk.24,28 Factors include:
o diet high in calories, animal fat, and refined carbohydrates and low in
fiber
o sedentary lifestyle
o body mass index [BMI]; and central deposition of adipose tissue

In both age-adjusted and multivariate analyses, reported diabetes

was associated with a significant increased risk of colorectal
cancer.24

Studies with varied methods showed a 2060% increase in

colorectal cancer risk in subjects with diabetes.24, 46
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 Diabetes & Colorectal Cancer (2)
A large population-based cohort study, found that:
o Men with diabetes had a statistically significant (49%)
increased risk of colorectal cancer after taking into account a
large number of potential confounders.24
o Individuals in the highest quartile of fasting glucose had a
nearly twofold increased risk of colorectal cancer.
o Glucose and insulin levels 2 hours after oral glucose
challenge were also significantly associated with incidence
of colorectal cancer.

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Khaw KT, Wareham N, Bingham S, Luben R, Welch A, Day N. Preliminary communication: glycated hemoglobin, diabetes, and incident colorectal
cancer in men and women: a prospective analysis from the European prospective investigation into cancer-Norfolk study.
Cancer Epidemiol Biomarkers Prev. 2004 Jun; 13(6): 915-9.
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 Diabetes & Colorectal Cancer (3)
Diabetics with CRC are more likely to relapse after surgery
and are more likely to die of CRC than non-diabetics.40
o Diabetics had a 21% higher chance of recurrence and a 42% lower
survival

Delayed stool transit and other gastrointestinal abnormalities

are commonly observed in persons with diabetes mellitus and
are also known to be associated with colorectal cancer.22

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Diabetes & Colorectal Cancer (4)
A prior diagnosis of type 2 diabetes mellitus was
associated with a modestly increased risk of
colorectal cancer.

The association between type 2 diabetes mellitus and

colorectal cancer was observed in both men and
women.

The risk increase was observed in both colon and

rectal cancers.
Yang YX, Hennessy S, Lewis JD. Type 2 diabetes mellitus and the risk of
colorectal cancer. Clin Gastroenterol Hepatol. 2005 Jun; 3(6): 587-94.

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Association between diabetes and colorectal cancer
incidence in case-control and cohort studies

Larson SC, Orsini N et al. J. Natl Cancer Inst. 2005, 97(22)

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Will, JC, Galuska, DA, Vinicor, F, Calle, EE. Colorectal Cancer: Another Complication of Diabetes Mellitus? American Journal of
Epidemiology. 1998; 149 (9): 816-825 12
 Conclusions
Diabetics might be at a higher risk for developing
colorectal cancer compared to non-diabetics.

Implications for colorectal cancer screening

guidelines for diabetics:
o Different screening guidelines for diabetics?

o More attention to diabetics to ensure their compliance

to standard screening guidelines?

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