Cancer incidence remains higher in people with type 2 diabetes, with the gap widening in recent years
· Medical Xpressby European Association for the Study of Diabetes
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A nationwide study presented at the annual meeting of the European Association for the Study of Diabetes (EASD) in Milan, Italy, Sept. 28–Oct. 2 has found that people with type 2 diabetes (T2D) have a higher risk of developing cancer. Cancer incidence has risen more among people with T2D than among those without diabetes over the past 25 years, largely driven by obesity-related cancers.
Based on data from the entire adult population of Denmark, the study found that overall cancer incidence was 12% higher among men with T2D and 22% higher among women with T2D than among those without diabetes in the most recent period (2010–2022). The corresponding differences between 1996 to 2009 were 9% and 15%.
"Our findings underline the growing cancer burden among people with T2D and highlight the need to prioritize cancer prevention and early detection as part of long-term diabetes care," said Dr. Tinne Laurberg of Steno Diabetes Center Aarhus at Aarhus University Hospital in Denmark, who led the research.
"This is especially important for common obesity-related cancers, such as colorectal and postmenopausal breast cancer, for which screening programs already exist in many countries. We must ensure that people with T2D benefit fully from these established programs by encouraging greater participation."
Cancer is a major health condition associated with T2D. Prolonged exposure to high blood sugar and insulin levels, as well as insulin resistance and ongoing inflammation, may contribute to cancer development.
Over the past decade, cancer has become the leading cause of death among people with T2D in Denmark and other high-income countries. This makes it important to understand how the incidence of different types of cancer has changed over time. However, population-level data on long-term cancer incidence trends in people with and without T2D are scarce.
For the study, researchers used data from nationwide health registries to compare the occurrence of new obesity-related and non-obesity-related cancers among adults (age 18 and older) with and without T2D living in Denmark between 1996 and 2022.
Participants were considered to have no diabetes until they were diagnosed with T2D, after which they were classified as having T2D. Follow-up began when participants turned 18, immigrated to Denmark or reached Jan. 1, 1996 (whichever occurred later), and continued until they were diagnosed with cancer, emigrated, died or reached Dec. 31, 2022.
Higher incidence particularly evident for obesity-related cancers
During 27 years of follow-up, 75,540 first cancers were identified among people with T2D and 635,323 among people without diabetes.
The higher cancer incidence among people with T2D was particularly evident for obesity-related cancers, which were 45% higher in men and 30% higher in women than among those without diabetes in 2010–2022. The corresponding differences between 1996–2009 were 34% and 23%, respectively.
However, patterns differed substantially by sex and cancer type.
Among the most common obesity-related cancers, postmenopausal breast cancer—the most common cancer among women—had an 8% higher incidence in women with T2D in 2010–2022. Similarly, colorectal cancer, the third most common cancer in both sexes, had a 17% higher incidence in men and a 14% higher incidence in women with T2D.
Patterns also differed for common cancers not classified as obesity-related. For example, prostate cancer, the most common cancer among men, had a 19% lower incidence among men with T2D than among those without diabetes in 2010–2022.
In contrast, lung cancer, the second most common cancer in both sexes, had a 23% higher incidence in men and a 25% higher incidence in women with T2D during this period. The difference was particularly notable in women: Incidence was 12% lower among those with T2D than among those without diabetes in 1996–2009, compared with 25% higher in 2010–2022.
According to Laurberg, "These findings support greater recognition of cancer as a major long-term complication of T2D. Cardiovascular and kidney disease prevention remains a key priority in diabetes care. However, as outcomes for these complications improve, cancer may require greater attention as part of the long-term care of people with type 2 diabetes.
"Our results underline the importance of considering cancer prevention and early detection alongside other established aspects of diabetes care, particularly for common cancers such as colorectal, lung and breast cancer."
The researchers emphasized that the study was designed to describe differences in cancer incidence between people with and without T2D, rather than to determine whether T2D itself causes these differences. Assessing factors that may contribute to the observed differences and changes over time, such as body weight, smoking, alcohol consumption and physical activity, was beyond the scope of the study.
They also noted that classifying a cancer as obesity-related reflects an established association with obesity at the population level and does not mean that obesity itself explains the differences in cancer incidence observed between people with and without T2D.
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OncologyEndocrinologyCommon illnesses & Prevention Provided by European Association for the Study of Diabetes Who's behind this story?
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