The DOI matches its Crossref record, with a small difference in title or year; 90 of the 90 references it cites were found in a registry or an index; none of the 32 sources its claims cite is checked for support yet.
Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus: A Systematic Review and Meta-analysis
Open accessAbstract
CONTEXT: Diabetes mellitus appears to be a risk factor for some cancers, but the effect of preexisting diabetes on all-cause mortality in newly diagnosed cancer patients is less clear. OBJECTIVE: To perform a systematic review and meta-analysis comparing overall survival in cancer patients with and without preexisting diabetes. DATA SOURCES: We searched MEDLINE and EMBASE through May 15, 2008, including references of qualifying articles. STUDY SELECTION: English-language, original investigations in humans with at least 3 months of follow-up were included. Titles, abstracts, and articles were reviewed by at least 2 independent readers. Of 7858 titles identified in our original search, 48 articles met our criteria. DATA EXTRACTION: One reviewer performed a full abstraction and other reviewers verified accuracy. We contacted authors and obtained additional information for 3 articles with insufficient reported data. RESULTS: Studies reporting cumulative survival rates were summarized qualitatively. Studies reporting Cox proportional hazard ratios (HRs) or Poisson relative risks were combined in a meta-analysis. A random-effects model meta-analysis of 23 articles showed that diabetes was associated with an increased mortality HR of 1.41 (95% confidence interval [CI], 1.28-1.55) compared with normoglycemic individuals across all cancer types. Subgroup analyses by type of cancer showed increased risk for cancers of the endometrium (HR, 1.76; 95% CI, 1.34-2.31), breast (HR, 1.61; 95% CI, 1.46-1.78), and colorectum (HR, 1.32; 95% CI, 1.24-1.41). CONCLUSIONS: Patients diagnosed with cancer who have preexisting diabetes are at increased risk for long-term, all-cause mortality compared with those without diabetes.
Overview
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Written from the paper’s full text.
TL;DR
In cancer patients with preexisting diabetes, pooled long-term all-cause mortality was significantly higher than in normoglycemic patients (HR 1.41; 95% CI, 1.28-1.55) across 23 studies. Significant site-specific increases were found for endometrial, breast, and colorectal cancers.
Key findings
- Meta-analysis of 23 studies found preexisting diabetes associated with increased all-cause mortality after cancer diagnosis: HR 1.41 (95% CI, 1.28-1.55).
- Site-specific pooled estimates were significant for endometrium (HR 1.76; 95% CI, 1.34-2.31), breast (HR 1.61; 95% CI, 1.46-1.78), and colorectum (HR 1.32; 95% CI, 1.24-1.41).
- Nonsignificant increases were reported for prostate (HR 1.51; 95% CI, 0.94-2.43), gastric (HR 1.36; 95% CI, 0.92-2.01), hepatocellular (HR 1.30; 95% CI, 0.99-1.70), lung (HR 1.15; 95% CI, 0.99-1.34), and pancreatic cancer (HR 1.09; 95% CI, 0.70-1.69).
- Sensitivity analyses excluding univariate estimates gave HR 1.40 (95% CI, 1.29-1.52); excluding analyses not adjusting/restricting for age and disease severity gave HR 1.42 (95% CI, 1.28-1.56). No significant publication bias was observed by Begg test (P = .92) or Egger plot (P = .34).
Methods
- Systematic review and meta-analysis searching MEDLINE and EMBASE through May 15, 2008; 7,858 titles identified, 48 articles met criteria for the systematic review of long-term all-cause mortality, and 23 studies met criteria for meta-analysis.
- Included English-language human original investigations with at least 3 months follow-up; meta-analysis required risk estimates (HR/RR) and precision estimates, with authors contacted for additional data.
- Random-effects meta-analysis using DerSimonian-Laird method; heterogeneity assessed with Cochran Q and I²; publication bias assessed with Begg funnel plot and Egger plot; sensitivity analyses and nonparametric sign test performed.
Limitations
- The paper states substantial heterogeneity across studies in demographics, diabetes ascertainment, and confounder adjustment; heterogeneity was significant by Q statistic (205 on 24 df, P < .001) and I² (88.3%, P < .001).
- The paper states studies spanned many decades (published 1969-2008), follow-up time was not always reported, and differences in follow-up may limit interpretation.
- Evident from the text: 9 studies with regression models had insufficient reporting for meta-analysis, only 3 of 12 contacted authors provided additional information, and many studies did not adjust for age and cancer severity; power was low (<50%) for prostate, gastric, hepatocellular, lung, and pancreatic cancer estimates.
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Claims the paper makes
30 Own result · 17 Not checked yet · 11 Own method · 7 Own interpretation · 1 No basis given
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Subgroup analyses by type of cancer showed increased risk for cancers of the endometrium (HR, 1.76; 95% CI, 1.34-2.31), breast (HR, 1.61; 95% CI, 1.46-1.78), and colorectum (HR, 1.32; 95% CI, 1.24-1.41).”
- Also stated in: § Sensitivity Analyses · plain
“Preexisting diabetes was significantly associated with increased long-term, all-cause mortality for cancers of the endometrium (HR, 1.76; 95% CI, 1.34-2.31), breast (HR, 1.61; 95% CI, 1.46-1.78), and colorectum (HR, 1.32; 95% CI, 1.24-1.41).”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Abstract > Results
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Sensitivity Analyses · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We performed a nonparametric sign test and found no association between diabetes and increased cancer-specific mortality (P=.69).”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Results > Cancer-Specific and Noncancer Mortality
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Diabetes was associated with a nonsignificant increase in risk in prostate (HR, 1.51; 95% CI, 0.94-2.43), gastric (HR, 1.36; 95% CI, 0.92-2.01), hepatocellular (HR, 1.30; 95% CI, 0.99-1.70), lung (HR, 1.15; 95% CI, 0.99-1.34), and pancreatic cancer (HR, 1.09; 95% CI, 0.70-1.69).”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Results > Sensitivity Analyses
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In our analysis, however, stage at diagnosis appeared not to be a major explanatory factor.”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Comment
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“No study included in this systematic review reported that diabetes was associated with significantly better survival.”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Results > Systematic Review of Evidence
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The large I2 value (88%) indicates that the range of plausible risk estimates is wide”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Comment
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“population-based studies (8 estimates) had a pooled HR of 1.39 (95% CI, 1.27-1.52)”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Results > Sensitivity Analyses
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Diabetes was associated with a nonsignificant increase in risk in prostate (HR, 1.51; 95% CI, 0.94-2.43), gastric (HR, 1.36; 95% CI, 0.92-2.01), hepatocellular (HR, 1.30; 95% CI, 0.99-1.70), lung (HR, 1.15; 95% CI, 0.99-1.34), and pancreatic cancer (HR, 1.09; 95% CI, 0.70-1.69).”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Results > Sensitivity Analyses
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Diabetes was associated with a nonsignificant increase in risk in prostate (HR, 1.51; 95% CI, 0.94-2.43), gastric (HR, 1.36; 95% CI, 0.92-2.01), hepatocellular (HR, 1.30; 95% CI, 0.99-1.70), lung (HR, 1.15; 95% CI, 0.99-1.34), and pancreatic cancer (HR, 1.09; 95% CI, 0.70-1.69).”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Results > Sensitivity Analyses
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We also calculated separate estimates for the 9 studies that considered diabetes as the primary exposure (HR, 1.42; 95% CI, 1.30-1.56)”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Results > Sensitivity Analyses
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- It may state two separate claims as one. 19
- Probably not a substantial claim. 17
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“A random-effects model meta-analysis of 23 articles showed that diabetes was associated with an increased mortality HR of 1.41 (95% confidence interval [CI], 1.28-1.55) compared with normoglycemic individuals across all cancer types.”
- Also stated in: § Meta-analysis · plain
“Preexisting diabetes was associated with an increase in all-cause mortality following cancer diagnosis (HR = 1.41; 95% CI, 1.28-1.55).”
- Also stated in: § Comment · plain
“Preexisting diabetes in cancer patients at the time of diagnosis was associated with an HR of 1.41 for the risk of all-cause mortality compared with individuals without diabetes when pooled across 23 studies of various types of cancer.”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Abstract > Results
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Also stated in: § Meta-analysis · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Of 9 estimates from 8 articles reporting the association of diabetes with cancer-specific mortality, 2 estimates found significantly higher risk,48,78 2 estimates found a nonsignificantly higher risk,36,77 2 estimates found a nonsignificantly lower risk,42,77 and 3 articles did not report a direction of effect.47,68,76”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Results > Cancer-Specific and Noncancer Mortality
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The sign test rejected the null hypothesis of equal mortality in patients with and without preexisting diabetes whether we excluded studies that did not report a direction of effect (P = .001) or assumed studies that did not report a direction of effect fell evenly in either category (5 each side, P=.005).”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Results > Systematic Review of Evidence
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- The authors state this as an assumption: In the sign test, studies that did not report a direction of effect fell evenly in either category.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The omission of any one study did not appreciably change the pooled HR, and the estimates in each case were well within the confidence limits of the overall estimate.”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Results > Sensitivity Analyses
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Heterogeneity was significant by the Q statistic (205 on 24 df, P < .001) and by I2 (88.3%, P < .001).”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Results > Meta-analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Our subsidiary analysis of studies that distinguished between cancer and noncancer mortality was inconclusive, so this possibility cannot be excluded.”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Comment
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Of the 3 studies evaluating noncancer mortality, 2 found a significant association with increased risk among patients with preexisting diabetes36,79 and 1 article reported a nonsignificant association with no direction of effect.67”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Results > Cancer-Specific and Noncancer Mortality
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Overall, 32 study estimates found diabetes was associated with increased risk of mortality, 7 found diabetes was associated with decreased risk of mortality, 1 found a null effect, and 10 did not report a direction of effect.”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Results > Systematic Review of Evidence
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
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- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“It is possible that high insulin or insulin-like growth factor levels may promote cancer cell and tumor growth.10”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Comment
What the sources say
- Not checked yetcites [10] Richardson LC Pollack LA Therapy insight: influence of type 2 diabetes on the development, treatment and outcomes of cancer Nat Clin Pract Oncol 2005 2 1 48 53 16264856
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“Because some cancers—including cancers of the breast,2 colorectum,3 endometrium,4 liver,5 and pancreas6—occur more commonly in individuals with diabetes”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Abstract > Conclusions
What the sources say
- Not checked yetcites [2] Larsson SC Mantzoros CS Wolk A Diabetes mellitus and risk of breast cancer: a meta-analysis Int J Cancer 2007 121 4 856 862 17397032
- Not checked yetcites [3] Larsson SC Orsini N Wolk A Diabetes mellitus and risk of colorectal cancer: a meta-analysis J Natl Cancer Inst 2005 97 22 1679 1687 16288121
- Not checked yetcites [4] Friberg E Orsini N Mantzoros CS Wolk A Diabetes mellitus and risk of endometrial cancer: a meta-analysis Diabetologia 2007 50 7 1365 1374 17476474
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Using the method described by Cohn and Becker,27 post hoc power calculations based on the overall and site-specific pooled HRs revealed excellent power (≥95%) for overall, endometrial, breast, and colorectal cancer estimates and low power (<50%) for prostate, gastric, hepatocellular, lung, and pancreatic cancer estimates.”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Methods > Data Synthesis and Statistical Analysis
What the sources say
- Not checked yetcites Cohn and Becker,27
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Diabetes is a well-established risk factor for cardiovascular mortality in adults without cancer,86”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Comment
What the sources say
- Not checked yetcites [86] Morrish NJ Wang SL Stevens LK Fuller JH Keen H Mortality and causes of death in the WHO Multinational Study of Vascular Disease in Diabetes Diabetologia 2001 44 suppl 2 S14 S21 11587045
boosteddirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“Third, patients with preexisting diabetes may have poorer response to cancer treatment, including increased infection risk and intraoperative mortality.39,81”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Comment
What the sources say
- Not checked yetcites [39] Meyerhardt JA Catalano PJ Haller DG Impact of diabetes mellitus on outcomes in patients with colon cancer J Clin Oncol 2003 21 3 433 440 12560431
- Not checked yetcites [81] Weiser MA Cabanillas ME Konopleva M Relation between the duration of remission and hyperglycemia during induction chemotherapy for acute lymphocytic leukemia with a hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone/methotrexatecytarabine regimen Cancer 2004 100 6 1179 1185 15022284
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Of the 12 authors contacted, 3 were able to provide additional information, 4 were unable to furnish the necessary information, and 5 did not respond to our request.”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Methods > Data Synthesis and Statistical Analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“Cancer patients with diabetes may receive less aggressive cancer treatment or less aggressive diabetes care, both of which could compromise survival.10”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Abstract > Conclusions
What the sources say
- Not checked yetcites [10] Richardson LC Pollack LA Therapy insight: influence of type 2 diabetes on the development, treatment and outcomes of cancer Nat Clin Pract Oncol 2005 2 1 48 53 16264856
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
In the paper
“Fleming et al83 found that women older than 67 years with preexisting diabetes had a 17% greater risk of being diagnosed with late vs early stage breast cancer in the SEER database compared with normoglycemic women.”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Comment
What the sources say
- Not checked yetcites Fleming et al83
plaincorrelational- Asserted: passes — The authors put it forward as true.
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- Load-bearing: fails — The paper’s conclusions may not depend on it.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Fourth, patients with preexisting diabetes may present with later-stage disease because of suboptimal cancer screening practices.82”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Comment
What the sources say
- Not checked yetcites [82] Beckman TJ Cuddihy RM Scheitel SM Naessens JM Killian JM Pankratz VS Screening mammogram utilization in women with diabetes Diabetes Care 2001 24 12 2049 2053 11723081
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“Adults with diabetes experienced increased cancer mortality in the American Cancer Society Cancer Prevention Study II,8 but not in the Second National Health and Nutrition Examination Survey Mortality Follow-Up.9”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Abstract > Conclusions
What the sources say
- Not checked yetcites [8] Coughlin SS Calle EE Teras LR Petrelli J Thun MJ Diabetes mellitus as a predictor of cancer mortality in a large cohort of US adults Am J Epidemiol 2004 159 12 1160 1167 15191933
- Not checked yetcites [9] Saydah SH Loria CM Eberhardt MS Brancati FL Abnormal glucose tolerance and the risk of cancer death in the United States Am J Epidemiol 2003 157 12 1092 1100 12796045
plaincorrelational- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Quality was assessed using elements of the STROBE checklist for cohort studies considered important for quality in these studies.11”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Methods > Data Extraction and Quality Assessment
What the sources say
- Not checked yetcites [11] von Elm E Altman DG Egger M Pocock SJ Gøtzsche PC Vandenbroucke JP STROBE initiative: the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies J Clin Epidemiol 2008 61 4 344 349 18313558
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“While the association of diabetes and site-specific mortality risk reached statistical significance only for cancers of the endometrium, breast, and colorectum, diabetes appeared to be associated with some additional mortality risk for all types of cancer.”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Comment
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The majority of the studies included in the review evaluated multiple prognostic variables, which likely decreased the risk of publication bias with respect to the relationship between diabetes and mortality in this patient population”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Comment
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Finally, differences in follow-up time, which was not always reported, may also limit interpretation of the results.”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Comment
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“One reviewer performed a full abstraction and other reviewers verified accuracy.”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Abstract > Data Extraction
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“However, experts in cancer epidemiology recognize that attribution of cause of death is often problematic and that undue reliance on attributed cause can bias estimates of risk related to cancer treatment.87-90”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Comment
What the sources say
- Not checked yetcites [87] Begg CB Schrag D Attribution of deaths following cancer treatment J Natl Cancer Inst 2002 94 14 1044 1045 12122090
- Not checked yetcites [88] Ederer F Geisser MS Mongin SJ Church TR Mendel JS Colorectal cancer deaths as determined by expert committee and from death certification: a comparison J Clin Epidemiol 1999 52 5 447 452 10360340
- Not checked yetcites [89] Welch HG Black WC Are deaths within 1 month of cancer-directed surgery attributed to cancer? J Natl Cancer Inst 2002 94 14 1066 1070 12122097
- Not checked yetcites [90] Lu TH Shih TP Lee MC Chou MC Lin CK Diversity in death certification: a case vignette approach J Clin Epidemiol 2001 54 11 1086 1093 11675159
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Fifth, the diagnosis and treatment of cancer may distract both the patient and the health care team from appropriate management of glycemia, blood pressure, and lipids, proven to reduce morbidity and mortality in diabetic adults.”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Comment
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Titles, abstracts, and articles were reviewed by at least 2 independent readers.”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Abstract > Study Selection
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“and the microvascular and macrovascular damage it causes likely accumulates to some extent regardless of cancer status.”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Comment
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it.
In the paper
“First, cancer patients with diabetes may have increased tumor cell proliferation and metastases in a physiologic environment of hyperinsulinemia and hyperglycemia.10”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Comment
What the sources say
- Not checked yetcites [10] Richardson LC Pollack LA Therapy insight: influence of type 2 diabetes on the development, treatment and outcomes of cancer Nat Clin Pract Oncol 2005 2 1 48 53 16264856
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“If several estimates were reported in the same article, we chose the most fully adjusted estimate (ie, multivariate regression was selected over univariate regression, which was selected over unadjusted Kaplan-Meier analysis).”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Methods > Data Synthesis and Statistical Analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“Another potential pathway is that acute exposure to hyperglycemia may increase endothelial cell permeability due to increased generation of reactive oxidative species and structural changes in the basement membrane, increasing the likelihood of metastasis.80”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Comment
What the sources say
- Not checked yetcites [80] Morss AS Edel ER Glucose modulates basement membrane fibroblast growth factor-2 via alterations in endothelial cell permeability J Biol Chem 2007 282 19 14635 14644 17327226
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“To avoid overlapping patient populations, we compared data on recruitment years, data source, and geographic location. If a patient population was found to overlap, we included the article with the most comprehensive population or most adjusted estimate of risk associated with preexisting diabetes. This resulted in the exclusion of 12 articles from our systematic review.12-23”
§ Long-term All-Cause Mortality in Cancer Patients With Preexisting Diabetes Mellitus > Methods > Data Synthesis and Statistical Analysis
What the sources say
- Not checked yetcites [12] Janssen-Heijnen ML Maas HA Houterman S Lemmens VE Rutten HJ Coebergh JW Comorbidity in older surgical cancer patients: influence on patient care and outcome Eur J Cancer 2007 43 15 2179 2193 17681780
- Not checked yetcites [13] Lemmens VE Janssen-Heijnen ML Verheij CD Houterman S Repelaer van Driel OJ Coebergh JW Co-morbidity leads to altered treatment and worse survival of elderly patients with colorectal cancer Br J Surg 2005 92 5 615 623 15779071
- Not checked yetcites [14] Tanisada K Teshima T Ikeda H Prognostic factors for patients with esophageal cancer treated with radiation therapy in PCS: a preliminary study Radiat Med 1998 16 6 461 468 9929147
- Not checked yetcites [15] Nagasue N Kohno H Tachibana M Yamanoi A Ohmori H El-Assal ON Prognostic factors after hepatic resection for hepatocellular carcinoma associated with Child-Turcotte class B and C cirrhosis Ann Surg 1999 229 1 84 90 9923804 PMC1191612
- Not checked yetcites [16] Huo TI Wu JC Lui WY Diabetes mellitus is a recurrence-independent risk factor in patients with hepatitis B virus-related hepatocellular carcinoma undergoing resection Eur J Gastroenterol Hepatol 2003 15 11 1203 1208 14560154
- Not checked yetcites [17] Hanbali A Al-Khasawneh K Cole-Johnson C Divine G Ali H Protective effect of diabetes against metastasis in patients with non-small cell lung cancer Arch Intern Med 2007 167 5 513 17353502
- Not checked yetcites [18] Merrick GS Butler WM Wallner KE Galbreath RW Allen ZA Adamovich E Androgen-deprivation therapy does not impact cause-specific or overall survival after permanent prostate brachytherapy Int J Radiat Oncol Biol Phys 2006 65 3 669 677 16682149
- Not checked yetcites [19] Kouvaris J Kouloulias V Loghis C Sykiotis C Balafouta M Vlahos L Prognostic factors for survival in invasive squamous cell vulvar carcinoma: a univariate analysis Gynecol Obstet Invest 2001 51 4 262 265 11408738
- Not checked yetcites [20] Janssen-Heijnen ML Lemmens VE van den Borne BE Biesma B Oei SB Coebergh JW Negligible influence of comorbidity on prognosis of patients with small cell lung cancer: a population-based study in the Netherlands Crit Rev Oncol Hematol 2007 62 2 172 178 17197191
- Not checked yetcites [21] Maas HA Kruitwagen RF Lemmens VE Goey SH Janssen-Heijnen ML The influence of age and co-morbidity on treatment and prognosis of ovarian cancer: a population-based study Gynecol Oncol 2005 97 1 104 109 15790445
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper relies on this without support.
The association of preexisting diabetes in newly diagnosed cancer patients with long-term, all-cause mortality has not been systematically assessed.
“However, the association of preexisting diabetes in newly diagnosed cancer patients with long-term, all-cause mortality has not been systematically assessed.”
The authors state this as an assumption.
Age and disease severity at cancer diagnosis are particularly important potential confounders.
“because we believe these are particularly important potential confounders.”
The authors state this as an assumption.
In the sign test, studies that did not report a direction of effect fell evenly in either category.
“assumed studies that did not report a direction of effect fell evenly in either category (5 each side, P=.005)”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“Results of some, but not all, epidemiological studies suggest that diabetes may significantly increase mortality in patients with cancer (8).”
From Diabetes and Cancer (2010) · cites this paper as [8]
Citations
Cites
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Cited by
Sorted by citations
Items 401–500 of 882
Ma, F.-J., Liu, Z.-B., Qu, L., Wu, J., Shao, Z.-M., Liu, G., & Hao, S. (2014) · OncoTargets and Therapy · doi:10.2147/ott.s71095 · Cited by 21
“…studies have also reported that T2DM is associated with worse cancer outcomes, including higher mortality, recurrence, and metastasis rates, 24–27 the particular influence of T2DM on early stage TNBC has not been established, because these prior studies did not specifically focus on this…”
Cai, Q., Luo, X., Liang, Y., Rao, H., Fang, X., Jiang, W., Lin, T., Lin, T., & Huang, H. (2013) · British Journal of Cancer · doi:10.1038/bjc.2012.566 · Cited by 21
“A study 384 www.bjcancer.com | DOI:10.1038/bjc.2012.566 indicated that cancer patients with pre-existing diabetes were often treated less aggressively than those without diabetes (van de Poll-Franse et al, 2007).”
InfluentialChen, M., Liu, X., Han, C., Wang, X., Zhao, Y., Pang, Q., Sun, X., Li, G., Zhang, K., Li, L., et al. (2020) · BMC Cancer · doi:10.1186/s12885-019-6461-z · Cited by 21
GLP-1 receptor agonists in the context of cancer: the road ahead
Miousse, I. R. (2025) · American Journal of Physiology-Cell Physiology · doi:10.1152/ajpcell.00245.2025 · Cited by 20
“In addition to having a higher cancer incidence, patients with T2D have been shown to have poorer cancer prognosis than patients without T2D (42–44).”
The effect of modifiable risk factors on breast cancer aggressiveness among black and white women
Killelea, B. K., Gallagher, E. J., Feldman, S. M., Port, E. R., King, T. A., Boolbol, S. K., Franco, R., Fei, K., Roith, D. L., & Bickell, N. A. (2019) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2019.07.012 · Cited by 20
An Analysis of the Multifaceted Roles of Heme in the Pathogenesis of Cancer and Related Diseases
Wang, T., Ashrafi, A., Modareszadeh, P., Deese, A. R., Castro, M. D. C. C., Alemi, P. S., & Li, Z. (2021) · Cancers · doi:10.3390/cancers13164142 · Cited by 20
Memon, A. A., Bennet, L., Zöller, B., Wang, X., Palmér, K., Sundquist, K., & Sundquist, J. (2014) · Journal of Diabetes · doi:10.1111/1753-0407.12184 · Cited by 20
Impact of Undetected Comorbidity on Treatment and Outcomes of Breast Cancer
Griffiths, R. I., Gleeson, M. L., Valderas, J. M., & Danese, M. D. (2014) · International Journal of Breast Cancer · doi:10.1155/2014/970780 · Cited by 20
“[32] cancer and other conditions.”
Choi, Y., Kim, T., Lee, K.-H., Han, S., Oh, D., Im, S., Kim, T., & Bang, Y. (2013) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2013.08.017 · Cited by 20
Non-small cell lung cancer cell survival crucially depends on functional insulin receptors
Frisch, C. M., Zimmermann, K., Zilleßen, P., Pfeifer, A., Racké, K., & Mayer, P. E. (2015) · Endocrine Related Cancer · doi:10.1530/erc-14-0581 · Cited by 19
Qiao, Z., Cheng-xue, D., Zhou, B., Li, S., Zhang, W., Jian-tao, J., Zhang, J., Ranran, K., & Ma, Y. (2012) · Journal of Biomedical Research · doi:10.7555/jbr.26.20110121 · Cited by 20
“O-GlcNAcation participates in the modification of protein and plays an important role in oncogenesis and progression of tumor and signal transduction([4-6]).”
BackgroundChen, J., Tao, F., Zhang, B., Chen, Q., Qiu, Y., Luo, Q., Gen, Y., Meng, J., Zhang, J., & Lü, H. (2017) · International Journal of Endocrinology · doi:10.1155/2017/5304391 · Cited by 20
“Accumulating evidence has shown that diabetes is associated with an increased risk for cancer [5, 6].”
BackgroundLam, C. J. K., Cronin, K. A., Ballard, R., & Mariotto, A. B. (2018) · Cancer Medicine · doi:10.1002/cam4.1554 · Cited by 20
The impact of cancer on diabetes outcomes
Arreskov, A. B., Olsen, M. Å., Pouplier, S. S., Siersma, V., Andersen, C. L., Friis, S., & Olivarius, N. D. F. (2019) · BMC Endocrine Disorders · doi:10.1186/s12902-019-0377-0 · Cited by 20
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“It is reported that 8%–18% of all cancer patients have pre-existing diabetes and diabetic cancer patients have a 42% increased mortality rate and a 21% increased rate of tumor recurrence as compared to nondiabetic patients [1,2].”
BackgroundHepatogenous Diabetes: A Primer
Nath, P., & Anand, A. C. (2021) · Journal of Clinical and Experimental Hepatology · doi:10.1016/j.jceh.2021.04.012 · Cited by 23
Effect of Diabetes Mellitus on the Outcome of Patients with Resected Non-Small Cell Lung Carcinoma
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“Altogether, it indicates that diabetic changes can delay but not prevent the NSCLC progression.In fact, most clinical studies suggested that DM is linked with either no risk or a higher risk for mortality of patients with lung carcinoma or other types of carcinoma [”
ResultWorndl, E., Fung, K., Fischer, H. D., Austin, P. C., Krzyzanowska, M. K., & Lipscombe, L. L. (2018) · JNCI Cancer Spectrum · doi:10.1093/jncics/pky008 · Cited by 20
“Diabetes has effects on both cancer-specific and noncancer mortality (3,4).”
BackgroundAn integrated care pathway for cancer patients with diabetes: A proposal from the Italian experience
Gallo, M., Clemente, G., Corsi, D. C., Michelini, M., SURACI, C., Farci, D., Ponziani, M. C., Candido, R., Russo, A. D., Musacchio, N., et al. (2019) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2019.04.036 · Cited by 19
“[3] Barone BB, Yeh HC, Snyder CF, et al.”
BackgroundType 2 diabetes and cancer: problems and suggestions for best patient management
Milluzzo, A., Vigneri, P. G., Martorana, F., Vigneri, R., & Sciacca, L. (2020) · Exploration of Medicine · doi:10.37349/emed.2020.00013 · Cited by 19
“First, diabetes increases susceptibility to infections, surgery/post-surgery mortality, and toxicity of therapies [12-14].”
BackgroundMnTE-2-PyP protects fibroblast mitochondria from hyperglycemia and radiation exposure
Chatterjee, A., Sakallioglu, I. T., Murthy, D., Kosmacek, E. A., Singh, P. K., McDonald, J. T., Powers, R., & Oberley‐Deegan, R. E. (2022) · Redox Biology · doi:10.1016/j.redox.2022.102301 · Cited by 20
“More than 15% of all cancer patients are diabetic, which enhances the overall mortality rate and tumor recurrence by 42% and 21% respectively as compared to the nondiabetic cancer patients [1,2].”
BackgroundZhan, Z., Liu, L., Cheng, M., Gao, Y., & Zhou, W. (2022) · Journal of Immunology Research · doi:10.1155/2022/2651790 · Cited by 20
Myocardial Protection and Current Cancer Therapy: Two Opposite Targets with Inevitable Cost
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The role of diabetes in metastatic melanoma patients treated with nivolumab plus relatlimab
Mallardo, D., Woodford, R. G., Menzies, A. M., Zimmer, L., Williamson, A. P., Ramelyte, E., Dimitriou, F., Wicky, A. M., Wallace, R., Mallardo, M., et al. (2023) · Journal of Translational Medicine · doi:10.1186/s12967-023-04607-4 · Cited by 21
“…risk factor for several types of cancer, and diabetic subjects have higher cancer-related mortality compared to subjects without diabetes [9–11], our results suggested that the reduced expression of LAG3 could hinder the effect of anti-LAG3 treatments in diabetic patients with advanced…”
ResultAl‐Taie, A., & Sheta, N. (2023) · Clinical Therapeutics · doi:10.1016/j.clinthera.2023.10.016 · Cited by 19
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“Diabetes mellitus is known to be closely associated with cancer because it causes increased mortality in patients with cancer, and hyperglycemic states might impair the duration of survival and outcomes in cancer patients (46).”
BackgroundThe impact of type 2 diabetes on the outcome of localized renal cell carcinoma
Höfner, T., Zeier, M. G., Hatiboglu, G., Eisen, C., Schönberg, G., Hadaschik, B. A., Teber, D., Duensing, S. M., Trumpp, A., Hohenfellner, M., et al. (2013) · World Journal of Urology · doi:10.1007/s00345-013-1231-z · Cited by 18
Hyperglycemia Promotes Human Gastric Carcinoma Progression via Aquaporin 3
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Retrospective database analysis of cancer risk in patients with type 2 diabetes mellitus in China
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Remodeling the Microenvironment before Occurrence and Metastasis of Cancer
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“Insulin and IGF-1 activate the PI3K/Akt/mTOR and Ras/Raf/ MAPK pathways[65-70].”
BackgroundMetformin exposure and survival in head and neck cancer: A large population-based cohort study
Alcusky, M. J., Keith, S. W., Karagiannis, T., Rabinowitz, C., Louis, D. Z., & Maio, V. (2019) · Journal of Clinical Pharmacy and Therapeutics · doi:10.1111/jcpt.12820 · Cited by 19
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“…T2DM compared to patients with cancer without T2DM; this may relate to the stage of tumor development, duration and status of the DM, age, and weight of the patient and the types of anticancer and antidiabetic therapies administered (Barone et al., 2008, 2010; Ma et al., 2014; Mao et al., 2015).”
BackgroundDiabetes and risk of tumors: oncologic considerations
Rosta, A. (2011) · Orvosi Hetilap · doi:10.1556/oh.2011.29158 · Cited by 19
The Impact of Diabetes Mellitus on Breast Cancer Outcomes: A Single Center Retrospective Study
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Obesity and Cancer: Concepts and Challenges
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“Diabetes and insulin resistance have been associated with increased incidence and worse prognosis for several types of cancer [48–51].”
Surveillance of the adult cancer survivor.
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Burke, S. J., Batdorf, H. M., Huang, T.-Y., Jackson, J. W., Jones, K. A., Martin, T. M., Rohli, K. E., Karlstad, M. D., Sparer, T. E., Burk, D. H., et al. (2019) · The Journal of Steroid Biochemistry and Molecular Biology · doi:10.1016/j.jsbmb.2019.105468 · Cited by 18
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“Studies have previously established the association between T2DM and an increased risk of both cancer mortality and all-causemortality.(9,32-35) Hypertension has also been associated with increased mortality for patients with cancer and portends a better prognosis when observed in response to certain therapies, such a…”
BackgroundDoose, M., Steinberg, M. B., Xing, C. Y., Lin, Y., Cantor, J. C., Hong, C., Demissie, K., Bandera, E. V., & Tsui, J. (2020) · Journal of General Internal Medicine · doi:10.1007/s11606-020-06234-x · Cited by 18
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“Previous studies have suggested that the presence of comorbidities increases the risk of all-cause mortality in patients with cancer [25-28].”
BackgroundLocal and Systemic Immune Dysregulation Alters Glioma Growth in Hyperglycemic Mice
Zhang, I. Y., Zhou, H., Liu, H., Zhang, L., Gao, H., Liu, S., Song, Y., Alizadeh, D., Yin, H. H., Pillai, R. K., et al. (2020) · Clinical Cancer Research · doi:10.1158/1078-0432.ccr-19-2520 · Cited by 18
“Individuals with Db have a significantly higher likelihood of developingmalignant tumors (1–5), and also have a higher risk of cancer-related mortality compared with non-Db patients (6).”
BackgroundSruthi, C. R., & Raghu, K. G. (2022) · Journal of Cellular Biochemistry · doi:10.1002/jcb.30215 · Cited by 17
“In line with these diabetic patients are more prone to cancer development along with a higher risk of mortality than cancer patients without diabetes.(15) However, some studies have shown the involvement of MGO in liver diseases.”
Background‘Tablet burden’ in patients with metastatic breast cancer
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Glycemic Status and Prognosis of Patients with Squamous Cell Carcinoma of the Esophagus
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Short-term adverse effects of anticancer drugs in patients with type 2 diabetes
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Lawrence, W. R., Hosler, A. S., Gates, M. A., Leinung, M. C., Zhang, X., Schymura, M. J., & Boscoe, F. P. (2020) · Cancer Epidemiology · doi:10.1016/j.canep.2020.101710 · Cited by 19
Wu, Q. F., Xu, Y., Bao, Y., Alvarez, J., & Gonzales, M. L. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9082584 · Cited by 17
Expression of GLP-1R protein and its clinical role in intrahepatic cholangiocarcinoma tissues
Chen, B., Zhao, W., Dong, J., & Si-Ma, H. (2014) · Molecular Biology Reports · doi:10.1007/s11033-014-3302-7 · Cited by 17
“Clinical studies have linked diabetes to the development of colorectal, [35–37] endometrial, and breast cancers [38, 39].”
BackgroundThe influence of diabetes severity on receipt of guideline-concordant treatment for breast cancer
Sabatino, S. A., Thompson, T., Wu, X., Fleming, S. T., Kimmick, G. G., Trentham‐Dietz, A., Cress, R. D., & Anderson, R. T. (2014) · Breast Cancer Research and Treatment · doi:10.1007/s10549-014-2998-3 · Cited by 17
Yang, W.-S., Chen, P., Lin, H., Su, T., Hsu, H., Chen, M.-F., Lee, Y., & Chien, K. (2017) · Acta Diabetologica · doi:10.1007/s00592-017-0966-1 · Cited by 17
“bladder) and lung cancer, are more limited and inconsistent [4, 5, 7, 9, 12].”
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dos Santos, E. S., Pérez‐de‐Oliveira, M. E., Normando, A. G. C., Gueiros, L. A., Rogatto, S. R., Vargas, P. A., Lopes, M. A., Guerra, E. N. S., Leme, A. F. P., & Santos‐Silva, A. R. (2022) · Head & Neck · doi:10.1002/hed.27193 · Cited by 16
Rodríguez-Carlos, A., Trujillo, V., Gonzalez-Curiel, I. E., Marín-Luevano, S. P., Torres-Juárez, F., Santos-Mena, A. O., Rivas-Santiago, C., Enciso‐Moreno, J. A., Zaga‐Clavellina, V., & Rivas-Santiago, B. T. (2020) · Archives of Medical Research · doi:10.1016/j.arcmed.2020.03.006 · Cited by 16
Ma, J.-W., Lai, T.-J., Hu, S.-Y., Lin, T., Ho, W., & Tsan, Y. (2020) · BMJ Open · doi:10.1136/bmjopen-2020-036955 · Cited by 16
Cazzaniga, M., Zonzini, G. B., Pierro, F. D., Moricoli, S., & Bertuccioli, A. (2022) · International Journal of Molecular Sciences · doi:10.3390/ijms232012538 · Cited by 16
“This is also confirmed by linking metabolic alterations of the glucose profile with an increase in incidence and mortality both in the presence of diabetes (type 1 and 2) and with the more nuanced conditions of hyperglycemia and hyperinsulinemia [7].”
BackgroundTalley, C. H., & Williams, K. P. (2015) · Nursing Clinics of North America · doi:10.1016/j.cnur.2015.05.008 · Cited by 16
Serum HER-2 concentration is associated with insulin resistance and decreases after weight loss
Fernández‐Real, J. M., Menéndez, J. A., Frühbeck, G., Moreno‐Navarrete, J. M., Vázquez‐Martín, A., & Ricart, W. (2010) · Nutrition & Metabolism · doi:10.1186/1743-7075-7-14 · Cited by 16
“A recent meta-analysis of 20 studies showed that women with (versus without) diabetes had a statistically significant 20% increased risk of breast cancer (RR, 1.20; 95% CI, 1.12-1.28) [ 6 ].”
BackgroundInfluentialBiomarkers of the Metabolic Syndrome and Breast Cancer Prognosis
Zhu, Q., Xu, W., & Tao, M. (2010) · Cancers · doi:10.3390/cancers2020721 · Cited by 16
“78) for breast cancer with pre-existing diabetes mellitus [109].”
BackgroundCRITICAL REVIEW IN PHARMACEUTICAL SCIENCES
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Survival and Recurrence With GLP-1 Receptor Agonists in Breast Cancer
Tatum, K. L., Dahman, B. A., Stevenson, A., Williford, S. E., Cassel, J. B., Zhao, H., Shen, J., McGuire, K. P., Diala, O. R., Oladimeji, R., et al. (2026) · JAMA Network Open · doi:10.1001/jamanetworkopen.2026.12133 · Cited by 16
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Mechanism and recent updates on insulin-related disorders
Kumar, S., Senapati, S., Bhattacharya, N., Bhattacharya, A., Maurya, S. K., Husain, H., Bhatti, J. S., & Pandey, A. K. (2023) · World Journal of Clinical Cases · doi:10.12998/wjcc.v11.i25.5840 · Cited by 17
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Li, T.-I., Chiang, M.-T., Chiu, K., Lai, C., Liu, S.-Y., & Shieh, Y. (2017) · Journal of Dental Sciences · doi:10.1016/j.jds.2016.12.002 · Cited by 15
“Epidemiological evidence supports the link between diabetes and certain cancers in different populations.(23) Obesity is strongly correlated with elevated levels of leptin, plasminogen activator inhibitor-1, and endogenous sex steroids, and decreased levels of adiponectin, resulting in insulin resistance and chronic i…”
BackgroundCong, M., Zhu, W., Wang, C., Fu, Z., Song, C., Dai, Z., Yao, K., Guo, Z., Lin, Y., Shi, Y., et al. (2020) · Cancer Medicine · doi:10.1002/cam4.3397 · Cited by 15
Badowska-Kozakiewicz, A. M., Fudalej, M. M., Kwaśniewska, D., Durlik, M., Nasierowska-Guttmejer, A. M., Mormul, A., Włoszek, E., Czerw, A. I., Banaś, T., & Deptała, A. (2022) · Cancers · doi:10.3390/cancers14122840 · Cited by 15
Xiu, W., Huang, Y., Li, Y., Yu, M., & Gong, Y. (2021) · Anti-Cancer Drugs · doi:10.1097/cad.0000000000001133 · Cited by 15
Diabetes mellitus: A significant co‐morbidity in the setting of lung cancer?
Washington, I. R., Chino, J., Marks, L. B., D’Amico, T. A., Berry, M. F., Ready, N., Higgins, K. A., Yoo, D. S., & Kelsey, C. R. (2012) · Thoracic Cancer · doi:10.1111/j.1759-7714.2012.00162.x · Cited by 15
Metformin and Cancer in Type 2 Diabetes
Park, H. K. (2013) · Diabetes & Metabolism Journal · doi:10.4093/dmj.2013.37.2.113 · Cited by 16
“Some observational studies have shown that diabetes is positively associated with the mortality of endometrial, breast, and colorectal cancer patients [2,4-6].”
BackgroundHypertriglyceridemia is Frequent in Endometrial Cancer Survivors
Hirasawa, A., Makita, K., Akahane, T., Yokota, M., Yamagami, W., Banno, K., Susumu, N., & Aoki, D. (2013) · Japanese Journal of Clinical Oncology · doi:10.1093/jjco/hyt125 · Cited by 15
Gallagher, E. J., LeRoith, D., Franco, R., Antoniou, I. M., Nayak, A., Livaudais‐Toman, J., & Bickell, N. A. (2016) · Diabetes/Metabolism Research and Reviews · doi:10.1002/dmrr.2795 · Cited by 15
Elwood, M., Tin, S. T., Kuper-Hommel, M. J. J., Lawrenson, R. A., & Campbell, I. (2018) · BMC Cancer · doi:10.1186/s12885-017-3971-4 · Cited by 15
Schwartz, S. S., Grant, S. F. A., & Herman, M. E. (2019) · Postgraduate Medicine · doi:10.1080/00325481.2019.1657358 · Cited by 16
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Physical Activity as a Standard Cancer Treatment
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“Previous meta-analyses have shown a poor survival associated with diabetes in patients with cancer, [8] including prostate, [9] pancreatic, [10] breast, [43] cervical, [44] colorectal, [45] lung, [46] and brain [47] cancer.”
ResultInterlinking of diabetes mellitus and cancer: An overview
Ahmad, I., Suhail, M., Ahmad, A., Alhosin, M., & Tabrez, S. S. M. (2023) · Cell Biochemistry and Function · doi:10.1002/cbf.3802 · Cited by 14
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Phenylethynylbenzyl-modified biguanides inhibit pancreatic cancer tumor growth
Hébert, A., Parisotto, M., Rowell, M., Doré, A., Ruiz, A. F., Lefrançois, G., Kalegari, P., Ferbeyre, G., & Schmitzer, A. R. (2021) · Scientific Reports · doi:10.1038/s41598-021-87993-3 · Cited by 14
Remission of type 2 diabetes after gastrectomy for gastric cancer: diabetes prediction score
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Diabetes mellitus and multiple myeloma; common features of two distinct entities
Tentolouris, A., Ntanasis‐Stathopoulos, I., Eleftheriadou, I., Malandrakis, P., Tzeravini, E., & Gavriatopoulou, M. (2022) · Diabetes/Metabolism Research and Reviews · doi:10.1002/dmrr.3535 · Cited by 14
“Records from studies examining the presence and the characteristics of peripheral neuropathy in patients with MM have shown that the prevalence of DM is high in this population.14‐16 A retrospective review of 1240 patients with MM examined the rate of DM and the impact of DM and anti‐diabetic therapies on MM clinical…”
BackgroundInfluentialHarvie, M. (2009) · Springer eBooks · doi:10.1007/978-1-4419-1173-5_5 · Cited by 14
“The decreased risk of all-cause mortality is illustrated by HRs (95% CI) of 1.85 (1.47–2.32) for diabetes, 1.65 (1.37–1.99) for hypertension and 1.78 (1.35–2.35) for CV disease [ 60 , 61].”
BackgroundInfluentialProteinuria predicts 10-year cancer-related mortality in patients with type 2 diabetes
Yu, T., Li, H., Jiang, Y., Chang, T., Wei, J., & Chuang, L. (2013) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2012.11.007 · Cited by 14
Hammer, M. J., Aouizerat, B. E., Schmidt, B. L., Cartwright, F., Wright, F., & Miaskowski, C. A. (2015) · Oncology nursing forum · doi:10.1188/15.onf.581-590 · Cited by 14
“About 18% of patients diagnosed with cancer have preexisting diabetes (Barone et al., 2008) compared to only 11% of the general population (National Institute of Diabetes and Digestive and Kidney Diseases [NIDDK], 2015).”
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Zhu, R. C., Rattanakorn, K., Pham, S., Mallam, D., McIntyre, T. P., Salifu, M. O., Youssef, I., McFarlane, S. I., & Vignesh, S. (2017) · Colorectal Cancer · doi:10.2217/crc-2017-0001 · Cited by 14
“Recent studies have shown that this drug is associated with a decrease in occurrence and overall cancer mortality in pre-surgical diabetics (DMs) [9].”
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“Furthermore, obesity in general is associated with diabetes as well as cardiovascular diseases[28, 29].”
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“A 9–11 Similarly, a history of cardiovascular diseases, such as myocardial infarction or stroke, could affect survival in individuals with cancer, especially among older patients with cancer where mortality related to cardiovascular disease can be higher than cancer mortality.”
Liu, J., Pek, S. L. T., Liu, S., Wang, J., Lee, J., Ang, K., Shao, Y. M., Gurung, R. L., Subramaniam, T., Tang, W. E., et al. (2021) · Clinical Chemistry · doi:10.1093/clinchem/hvab172 · Cited by 13
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Intersections of endocrine pathways and the epithelial mesenchymal transition in endometrial cancer
Gelissen, J. H., & Huang, G. S. (2022) · Frontiers in Oncology · doi:10.3389/fonc.2022.914405 · Cited by 13
Yue, C., Zhang, C., Ying, C., & Jiang, H. (2022) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.993785 · Cited by 15
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“In support of these, clinical studies have indicated that anti-diabetic therapies such as metformin use are associated with improved prognosis of BC [11, 12].”
ResultZahra, M. H., Afify, S. M., Hassan, G., Nawara, H. M., Kumon, K., Seno, A., & Seno, M. (2021) · Cell Biochemistry and Function · doi:10.1002/cbf.3661 · Cited by 13
Chiu, S. Y., Chen, Y. I., Lu, J.-F. R., Ng, S., & Chen, C. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10204779 · Cited by 13
“Epidemiological studies and the biological mechanism of inflammation in diabetes have demonstrated that diabetes is an independent risk factor for the incidence of specific cancers and increases the risk of all-cause mortality and poor prognosis [21].”
Background
Metadata
- Authors
- Barone, B. B.
- Affiliations
- Johns Hopkins University (US)
- Corresponding author
- Barone, Bethany B.
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2008-12-17
- Volume
- 300
- Issue
- 23
- Pages
- 2754
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC3093051
- OpenAlex
- W1968234252
- Cited by
- 881
- References
- 89
- Citations by year
- 2026: 22 · 2025: 35 · 2024: 67 · 2023: 42 · 2022: 53 · 2021: 52 · 2020: 62 · 2019: 53 · 2018: 50 · 2017: 53 · 2016: 46 · 2015: 47 · 2014: 53 · 2013: 60 · 2012: 57
- FWCI
- 17.57
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (5p60dk079637-02)
- U.S. Public Health Service (T32HP10025-14)
- National Institute of Diabetes and Digestive and Kidney Diseases (P60 DK-079637, K24-DK62222, K24DK062222, P30DK079637, T32DK062707)
- National Center for Research Resources (UL1RR025005)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Metabolism, Diabetes, and Cancer
- Health Sciences › Medicine › Oncology › Cancer Risks and Factors
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- diabetes mellitus, cancer, all-cause mortality, overall survival, endometrial cancer, breast cancer, colorectal cancer, comorbidities, cancer risk factors
- MeSH terms
- Cause of Death, Diabetes Mellitus, Humans, Neoplasms, Risk Factors, Comorbidity, Survival Analysis
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