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TOPLINE:

Diabetes is associated with more than double the risk for cancer among Hispanic and Latino adults in the US, with 715 cancers diagnosed over a mean follow-up of 10.7 years. Uncontrolled diabetes and higher insulin resistance further elevate cancer risk, particularly for obesity-related cancers.

METHODOLOGY:

• The association between diabetes and cancer risk has been extensively investigated, with a recent meta-analysis estimating that diabetes is associated with a 15% increase in cancer risk, ranging from 10% for breast cancer to 123% for liver cancer. Hispanic and Latino adults have been largely underrepresented in studies of diabetes and cancer incidence despite their disproportionate burden of diabetes, with few studies including appropriate representation of the diversity of the Hispanic and Latino populations.
• Researchers conducted a multisite prospective cohort study involving 16,415 Hispanic and Latino adults aged 18-74 years from Chicago; Miami; Bronx, New York; and San Diego, enrolled between 2008 and 2011.
• Participants underwent clinical examinations at visit 1 (2008-2011) and visit 2 (2014-2017), with time-varying diabetes measures including diabetes status, glycemic control based on A1c levels, and insulin resistance assessed using the homeostatic model assessment of insulin resistance.
• Incident cancers diagnosed from visit 1 through 2021 were identified through state cancer registry linkages in California, Florida, New York, and Illinois, with 715 cancers including 330 obesity-related cancers diagnosed over a mean follow-up of 10.7 years.
• Analysis utilized survey-weighted marginal structural Cox regression models with stabilized inverse probability of treatment weights to estimate hazard ratios and 95% CIs, adjusting for demographic, social, and behavioral characteristics including age, sex, heritage, education, BMI, smoking, alcohol use, diet quality, physical activity, and insurance status.

TAKEAWAY:

• Both having time-varying prediabetes and diabetes were associated with cancer compared with not having diabetes, with hazard ratios (HRs) of 1.82 and 2.49, respectively.
• HRs were elevated among those with diabetes and A1c > 7.0% (HR, 3.12) and those with diabetes and a homeostatic model assessment of insulin resistance > 3.0 (HR, 2.78).
• Having diabetes was associated with an obesity-related cancer (HR, 2.57), with the highest risk among those with diabetes and A1c > 7.0% (HR, 4.99; 95% CI, 1.73-14.32).
• Sex did not significantly modify the association between diabetes status and overall cancer risk (P for interaction = .41) or obesity-related cancer risk (P for interaction = .40).

IN PRACTICE:

“Diabetes prevention and control may be additionally important for cancer prevention among Hispanic or Latino adults,” wrote the authors of the study.

SOURCE:

The study was led by Humberto Parada Jr, PhD, MPH, Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University (SDSU), San Diego. It was published online in Cancer.

LIMITATIONS:

According to the authors, the participants were relatively young at enrollment, resulting in a relatively small number of cancer cases (715 total, 330 obesity-related), which limited statistical power, particularly for stratified analyses, and precluded the examination of individual cancer sites. The authors noted limited power to examine effect modification by Hispanic or Latino background given the relatively low prevalence of diabetes and relatively low incidence of cancer. There is potential for under-ascertainment or misclassification of cancer outcomes because cancers were not adjudicated, which would require additional resources. Residual confounding is possible due to covariates that were unmeasured, such as occupational or environmental exposures, or that were only measured at baseline, such as physical activity and diet quality.

DISCLOSURES:

The study received support from the National Heart, Lung, and Blood Institute through contracts to the University of North Carolina at Chapel Hill, University of Miami, Albert Einstein College of Medicine, Northwestern University, and SDSU. Additional funding was provided through transfers from the National Institute on Minority Health and Health Disparities, National Institute on Deafness and Other Communication Disorders, National Institute of Dental and Craniofacial Research, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Neurological Disorders and Stroke, and Office of Dietary Supplements. Parada reported receiving support from the National Cancer Institute, the National Institute on Minority Health and Health Disparities, and the San Diego Alzheimer’s Disease Resource Center for Advancing Minority Aging Research at the University of California San Diego. Corinne McDaniels-Davidson reported receiving support from SDSU Faculty United towards Excellence in Research and Transformational Engagement; the SDSU-University of California, San Diego (UCSD) Cancer Research and Education to Advance HealTh Equity Partnership; and the UCSD Moores Cancer Center. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.