Metabolic syndrome and cancer risk

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Abstract

Objective

The purpose of this population-based study is to explore for the first time the link between metabolic syndrome and cancer risk using information from the health information system of the Cancer Registry.

Methods

Referring to all pharmaceutical prescriptions between 1 January 1999 and 31 December 2005, coded with the Anatomical Therapeutic Chemical classification, all subjects aged 40 and over resident in Milan, which were simultaneously prescribed with antihypertensive, hypolypemic and hypoglycaemic drugs, were considered affected by metabolic syndrome. New cancer cases among cohort subjects were identified trough the local Cancer Registry and standardised incidence ratios (and corresponding 95% exact confidence intervals) were computed.

Results

Overall 16,677 subjects were identified corresponding to 45,828 person-years; among them 823 incidents cancers occurred. Significantly increased risks for pancreatic cancer in males - SIR 178 (114–266) - and colorectal cancer in females - SIR 133 (101–170) - were observed. Non-significantly increased risks were also observed in women for liver, gallbladder and biliary tract, breast and endometrial cancers.

Conclusions

Our study suggests that the risk for several cancers increases in subjects affected by metabolic syndrome. The pharmacological control of the syndrome seems to be inadequate for reducing cancer risk, even though both a high competitive mortality effect and short duration of follow up have to be considered.

Introduction

Metabolic syndrome is defined as a combination of cardiovascular risk factors which include increased body mass index (or waist circumference), blood pressure, glycemia, and serum triglycerides, as well as a decrease in high-density lipoprotein cholesterol.1, 2, 3, 4

Interestingly, most components of metabolic syndrome have each been linked in some way to the development of cancer. Hypertension may increase cancer risk by blocking and subsequently modifying apoptosis, thereby affecting cell turnover.5, 6 Several studies showed a positive relationship between diabetes and pancreatic and liver cancers caused by the insulin excess which promotes the development of cancer cells in the liver and pancreas.7, 8, 9, 10, 11 Obesity is a major risk factor for cancer; prospective studies indicate that overweight and obesity account for 14% of all cancer deaths in men and 20% in women.12 Obesity is implicated in aetiology and progression of cancer at multiple cancer sites by means of signalling pathways that regulate key functions, including cancer cell proliferation, apoptosis, metastasis, and angiogenesis.13, 14, 15

Yet, bearing such evidence, based on the related components of metabolic syndrome, epidemiological studies linking metabolic syndrome to cancer are scarce.16, 17, 18, 19, 20

The purpose of this study is to explore the relationship between metabolic syndrome and cancer risk. Referring to the health information system and to the Cancer Registry of Milan, subjects simultaneously treated with hypoglycaemic, anti-hypertensive and hypolipemics drugs were assigned to a pharmacological diagnosis of metabolic syndrome. Specifically, under the hypothesis that those subjects have a higher risk of developing cancer, we systematically analysed their risk cancer differences with the general population across all cancer sites.

Section snippets

Materials and methods

This study was carried out using Milan’s Health Authority information system, which covers the largest metropolitan population in the North of Italy (about 1,300,000 inhabitants).

All drugs prescribed to the resident population of Milan are listed in the Pharmaceutical Prescriptions Archive and coded with the Anatomical Therapeutic Chemical (ATC) classification. All pharmaceutical prescriptions in the time period between 1 January 1999 and 31 December 2005 (N = 42,626,531) were retrieved to

Results

A total of 16,677 subjects exposed simultaneously to antihypertensive, hypoglycaemic and hypolypemic treatments were identified and enrolled in the study.

Case follow-up lasted up to 8-years, with an average follow up period of 2.7 years, and a total of 45,828 person-years. During the study period 823 incidents cancers were identified. Table 1 shows the absolute and the expected frequencies of new occurrences by site as classified by ICD-X.

The expected number of invasive cancers, derived from

Discussion

Adopting a pharmacologically based definition of metabolic syndrome, our study identified a positive association of this nosological entity with several cancer sites. In particular, the strongest associations were found with pancreatic cancer in men and colorectal cancer in women, but remarkable risk increases were identified for several sites (liver cancer in males and biliary tract and corpus uteri in females).

Our study has several important strengths: it is population based; results are

Conflict of interest statement

None declared.

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