Diabetes and risk of bladder cancer among postmenopausal women in the Iowa women’s health study

Abstract

Studies have indicated that diabetes is a risk factor for bladder cancer; however, many failed to adjust for confounding variables. An earlier publication from the Iowa Women's Health Study reported a positive association of baseline diabetes with bladder cancer risk between 1986 and 1998, although the number of cases was small (n=112). We re-examined the diabetes-bladder cancer risk association by accounting for 12 more years of follow-up and assessed whether the association varied by diabetes duration, body mass index, or waist-to-hip ratio (WHR). Proportional hazards regression was used to estimate the hazard ratio (HR) of bladder cancer (n=277) in relation to diabetes (before enrollment and during follow-up) and diabetes duration using a time-dependent approach. In a multivariate time-dependent analysis, the HR for bladder cancer was 1.69 (95% CI 1.40-2.41) in relation to diabetes among 37,327 postmenopausal women initially free of cancer. There was an interaction between diabetes and WHR (p=0.01). Bladder cancer HR in diabetic women with WHR>0.9 was 2.5 times higher than expected. There was no dose-response relation of bladder cancer risk with diabetes duration. Compared to no diabetes, HRs were 1.77, 2.03, and 1.55 for diabetes durations of ≤5, 6-10, and >10years, respectively. We confirmed a positive association between diabetes and bladder cancer risk among white postmenopausal women. We also observed a synergistic interaction between diabetes and high WHR in bladder cancer development that might be explained by increased insulin resistance and inflammation related to abdominal obesity.