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Diabetes increased risk for head, neck cancers
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Patients with diabetes demonstrated an increased risk for head and neck cancers, particularly malignancies of the oral cavity, oropharynx and nasopharynx, according to results of a retrospective cohort study.
Researchers used Taiwan’s Longitudinal Health Insurance Research Database to identify 89,089 patients newly diagnosed with diabetes. The analysis also included a cohort of individuals without diabetes matched for sex, age and comorbidities, including obesity, coronary artery disease, hyperlipidemia and hypertension.
Overall, patients with diabetes demonstrated a 1.47-fold increased risk for developing a head and neck cancer compared with those in the control population (adjusted HR=1.48; 95% CI, 1.31-1.67). The greatest risks were for development of oral cavity cancer (adjusted HR=1.74; 95% CI, 1.47-2.06), oropharyngeal cancer (adjusted HR=1.53; 95% CI, 1.01-2.31) and nasopharyngeal carcinoma (adjusted HR=1.4; 95% CI, 1.03-1.89).
Among individuals aged 40 to 65 years, head and neck cancers occurred significantly more frequently in those with diabetes than those without diabetes (incidence rate ratio [IRR]=1.57; 95% CI, 1.36-1.82). Men with diabetes also demonstrated a significantly greater risk for head and neck cancers than men without diabetes (IRR=1.48; 95% CI, 1.31-1.69).
However, researchers noted comorbidities had no statistically significant effect on the difference in incidence of head and neck cancers between the two cohorts (hypertension, P=.59; hyperlipidemia, P=.80; coronary artery disease, P=.46; chronic kidney disease, P=.85; and chronic obstructive pulmonary disease, P=.45).
OS among all patients with head and neck cancers was comparable, regardless of whether they had diabetes (P=.22). However, among individuals without head and neck cancers, those without diabetes demonstrated significantly longer OS than those who had diabetes (P˂.001).
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Marwan Hamaty, MD
The study by Tseng et al shows for the first time a strong association between diabetes and head and neck cancers. Those with diabetes had 40% greater risk.
The authors attributed the higher cancer risk among people with diabetes to adequate correction for confounding risk factors, which made the risk more obvious. Shared genetic risk factors that could expose individuals to both cancer and diabetes were postulated as a possible explanation. This theory is plausible. At the same time, it is crucial to look further to modifiable risk factors that we can influence.
Tobacco use is major risk factor for development of both diabetes and head and neck cancers. The adjustment for chronic obstructive pulmonary disease (COPD) in this study does not fully adjust for the risk of tobacco use. Only a portion of smokers would have clinically diagnosed and documented COPD. Likely, smoking history had confounded the results. Therefore, a priority for our patients who use tobacco is to receive counseling and treatments aimed to achieve abstinence from tobacco use and, at the same time, avoid weight gain that could result from tobacco use cessation.
Lifestyle habits play significant roles in the risk for cancers and they are difficult to control for in a retrospective study despite adjustments for other socioeconomic factors. Head and neck cancers incidence was lower in association with diet low in saturated (animal) fat and higher in fiber and fruit, findings similar to those in studies of other types of cancers. These are other modifiable risk factors. Further, limiting saturated fat and increasing dietary fiber are among the dietary recommendations for our patients with diabetes and hyperlipidemia. It is crucial that all patients receive adequate dietary management.
Hyperglycemia and its treatments also were mentioned among the possible explanations. Hyperglycemia remains both a plausible and controversial explanation. From a practical point of view, there are plenty of reasons why adequate glycemic control is needed (eg, improvement of symptoms, quality of life, and prevention of long-term microvascular complications.
Medications to treat diabetes have been under scrutiny as possible causes as well as possible preventive/alleviating agents. To date, there is no conclusive evidence of either possibility, despite large volumes of literature in this area. Medications should be used to treat hyperglycemia, as it seems to be appropriate from glycemic control point of view and according to their known (documented and proven) benefits, safety profile and side effects.
Detection bias often is a confounding factor in retrospective studies. It could overestimate the incidence of cancers among patients with diabetes who have more frequent office visits and who are at higher chance of having their medical conditions diagnosed. How can we ensure early diagnosis of cases among people without diabetes? More importantly, how could we deliver preventive measures to “healthy” people? We clearly still have a long way to go in improving public health.
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