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Insulin May Increase Colon Cancer Risk
Insulin May Increase Colon Cancer Risk -- Posted by Gumbo on 10-23-04 05:53
Insulin May Increase Colon Cancer Risk
Research Suggests Twofold to Threefold Increase in Risk Among Long-Term
Users
By Salynn Boyles
WebMD Medical News Reviewed By Charlotte Grayson, MD
on Friday, October 01, 2004
Oct. 1, 2004 -- People with type 2 diabetes who require insulin injections
to control their disease may be at increased risk for colorectal cancer,
according to findings from a newly published study. But a diabetes expert
who spoke with WebMD remains unconvinced.
Researchers from the University of Pennsylvania School of Medicine concluded
that people with diabetes who had been taking insulin for three to five
years had almost a threefold increase in colorectal cancer risk compared
with those who did not take insulin. This risk is similar to someone with a
strong family history of the cancer. The risk was even higher in people who
took insulin for more than five years. The study was published in the
October issue of the journal Gastroenterology.
Since type 2 diabetes and colorectal cancer share many of the same risk
factors, the findings do not prove that insulin promotes the growth of
tumors. But lead researcher Yu-Xiao Yang, MD, says the study offers
compelling evidence that this may be the case.
He tells WebMD that the increase in colon cancer risk seen among long-time
insulin users was much greater than has been seen among people with type 2
diabetes overall.
Previous lab studies also suggest that insulin may promote the growth of
colon cancer.
But American Diabetes Association immediate past-president Gene Barrett, MD,
says the study was too small to prove the association. The study included
just 10 people with type 2 diabetes and colorectal cancer who took insulin
for three or more years.
"These authors conclude that long-term insulin therapy significantly
increases the risk of colorectal cancer, but they don't have the data to
support that claim," says Barrett, who is professor of medicine at the
University of Virginia.
Screening Is Key
Colorectal cancer is the second leading cause of cancer-related deaths in
the U.S., but it is also one of the most highly treatable cancers when
detected early. Like type 2 diabetes, risk factors that have been implicated
as promoters of colorectal cancer include western diets high in fat and
refined grains (such as white bread and white rice), being overweight, and
leading a sedentary lifestyle.
Barrett and Yang agree that it is particularly important for people with
type 2 diabetes to strictly follow guidelines regarding colorectal cancer
screening, but both say it is too soon to recommend more aggressive cancer
screening for this population.
Guidelines for the population at large call for regular colorectal cancer
screening beginning at age 50, with subsequent screenings determined by the
screening method chosen and a person's individual risk factors. People
considered at high risk for the colorectal cancer are usually advised to
begin screening earlier.
"At this point we have no evidence that more aggressive screening is
beneficial," Yang says. "The colorectal cancer screening procedures that are
now in place are very, very effective. They essentially reduce risk by about
70%."
An Aspirin a Day
Because screening is so effective, Yang says people with diabetes who take
insulin and who get screened when they should have little cause for concern.
"Nobody should discontinue insulin therapy or change their therapy based on
this study," he says. "There is absolutely no need for that."
Barrett says the findings, if confirmed, also give people with type 2
diabetes another reason to take a daily low-dose of aspirin if their doctor
advises them to do so. Aspirin therapy is widely recommended for people with
type 2 diabetes because they are at increased risk for heart disease.
"Aspirin has been shown to protect the heart, and there is also good
evidence that it reduces colorectal cancer risk," he says. "Most of my [type
2 diabetes] patients ... are taking aspirin."
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SOURCES: Yang, Y. Gastroenterology, October 2004; vol 127: pp 1044-1050.
Yu-Xiao Yang, MD, MSCE, division of gastroenterology and Center for Clinical
Epidemiology and Biostatistics, University of Pennsylvania School of
Medicine, Philadelphia. Gene Barrett, MD, immediate past president, American
Diabetes Association; professor of medicine, University of Virginia.
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