Background: Evidence suggests that participation in cancer screening may be lower among individuals with type 2 diabetes (T2D) or cardiovascular diseases (CVD) diagnosed prior to cancer compared to individuals with cancer without cardiometabolic diseases. Therefore, cardiometabolic diseases may lead to late cancer detection and advanced stage at diagnosis. This study aimed to investigate whether pre-existing cardiometabolic diseases are associated with stage at cancer diagnosis.
Material and methods: Within the European Prospective Investigation into Cancer and Nutrition cohort (EPIC), incident localised and metastatic cancers were diagnosed between 1992 and 2012. Participants with incident diagnosis of cardiometabolic diseases, including CVD and T2D, prior to cancer were identified. Multi-variable adjusted logistic regression was used to estimate odds-ratios (OR) and 95% confidence intervals (CI) of diagnosis of metastatic cancer according to the presence of CVD, T2D, both or no cardiometabolic disease among EPIC participants diagnosed with cancer. Analyses were carried out for all cancers combined and separately for screened cancers (breast and colorectal cancer) and non-screened cancers (all cancers except breast and colorectal cancer) based on the availability of population-based cancer screening programs in Europe.
Results: Of the 11,945 incident cancers,4.8% were diagnosed with CVD, 7.1% with T2D and 1.3% were diagnosed with both CVD and T2D. When we excluded screenable cancer sites from our sample, we observed that individuals with T2D more likely to be diagnosed with metastatic cancer at diagnosis compared to individuals with neither T2D nor CVD (OR 1.26, 95% CI 1.04–1.55).
Conclusions: These findings suggest an increased risk of advanced tumour stage at diagnosis, particularly for non-screenable cancers, among individuals with pre-existing T2D. The results underline the importance of encouraging participation of the eligible population in screening programmes by healthcare professionals and pay special attention to individuals with preexisting cardiometabolic diseases.
Table 1:Association of pre-existing cardiometabolic comorbidities and cancer stage at diagnosis
| N (localized) | N (metastatic) | OR | 95% CI | |
|---|---|---|---|---|
| Screened cancers | ||||
| Breast cancer (N = 2823) | ||||
| No | 1824 | 806 | ref | |
| comorbidities | ||||
| CVD | 41 | 12 | 0.71 | (0.35–1.41) |
| T2D | 90 | 41 | 0.88 | (0.59–1.33) |
| T2D & CVD | 5 | 4 | 1.15 | (0.68–2.52) |
| Colorectal cancer (N = 1722) | ||||
| No | 793 | 688 | ref | |
| comorbidities | ||||
| CVD | 45 | 33 | 0.69 | (0.42–1.13) |
| T2D | 74 | 59 | 0.93 | (0.63–1.38) |
| T2D & CVD | 20 | 10 | 0.68 | (0.29–1.59) |
| Non-screened cancers (N = 7400) | ||||
| No CM | 243 | 565 | ref | |
| comorbidities | ||||
| CVD | 30 | 65 | 1.07 | (0.85–1.34) |
| T2D | 26 | 41 | 1.26 | (1.04–1.55) |
| T2D & CVD | 4 | 16 | 1.18 | (0.78–1.78) |
No conflict of interest.
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