Prospective study reveals associations between colorectal cancer and type 2 diabetes mellitus or insulin use in men

Peter T. Campbell, Anusila Deka, Eric J. Jacobs, Christina C. Newton, Janet S. Hildebrand, Marjorie L. McCullough, Paul J. Limburg, Susan M. Gapstur

Research output: Contribution to journalArticlepeer-review

100 Scopus citations


Background & Aims Type 2 diabetes mellitus (DM) is associated with an increased risk of colorectal cancer (CRC); it is not clear if this association varies by sex or other factors. Insulin use might also be associated with CRC risk. We investigated associations of type 2 DM and insulin use with CRC risk. Methods The Cancer Prevention Study II Nutrition Cohort is a prospective study of cancer incidence. In 1992 or 1993, adult participants (n = 184,194) completed a detailed, self-administered questionnaire. Follow-up questionnaires were sent in 1997 and every 2 years thereafter. Cox proportional hazards regression analysis was used to calculate relative risks (RR) and 95% confidence intervals (CI), adjusting for covariates. Results After exclusions, 73,312 men and 81,663 women remained in the final analytic cohort; 1567 men (227 with type 2 DM) and 1242 women (108 with type 2 DM) were diagnosed with colon or rectal cancer by 2007. Among men, type 2 DM was associated with increased risk of incident CRC compared to not having type 2 DM (RR: 1.24; 95% CI: 1.08-1.44); risk was higher for participants with type 2 DM using insulin (RR: 1.36; 95% CI: 1.05-1.78), and participants with type 2 DM not using insulin (RR: 1.22, 95% CI: 1.04-1.45). Among women, type 2 DM and insulin use were not associated with risk of incident CRC (RR: 1.01; 95% CI: 0.82-1.23 and RR: 0.95; 95% CI: 0.64-1.41, respectively). Conclusions There is a modest association between type 2 DM and CRC among men, but not women. Insulin use is not associated with a substantially increased risk of CRC.

Original languageEnglish (US)
Pages (from-to)1138-1146
Number of pages9
Issue number4
StatePublished - Oct 2010


  • Carcinogenesis
  • Cigarette Smoking
  • Colon Cancer
  • Family History

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology


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