Prevalence of Cancers of Female Organs among Patients with Diabetes Type 2 in Kelantan, Malaysia: Observations over an 11 Year Period and Strategies to Reduce the Incidence.

Nur Asyilla Che Jalil,Nor Hayati Othman,Anani Aila Mat Zin

doi:10.7314/apjcp.2015.16.16.7267

Nur Asyilla Che Jalil, Nor Hayati Othman + Show 1 more

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https://doi.org/10.7314/apjcp.2015.16.16.7267

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Abstract

Kelantan is one of the states in Malaysia which has a high prevalence of type 2 diabetes (DM2). Other than with endometrial carcinoma, the association of DM2 with particular female cancers is not known. To determine the proportion of breast, cervical, ovarian and endometrial cancers among females with DM2 diagnosed in Hospital Universiti Sains Malaysia (HUSM) over an 11 year period. All histologically confirmed cases of breast, endometrial, cervical and ovarian carcinomas admitted to the Hospital were included in the study. The patient diabetic status was traced from the hospital medical records. There was a total of 860 cases of breast, cervical, ovarian and endometrial carcinomas over this period. Breast carcinoma was the commonest, accounting for 437/860 (50.8%) followed by cervix, 159/860 (18.5%), ovarian, 143/860 (16.6%) and endometrial carcinomas, 121/860 (14.1%). Out of these, 228/860 (26.5%) were confirmed diabetics. Endometrial carcinoma patients showed the highest proportion being diabetics, 42.1% (51/121), followed by ovarian cancer, 25.9% (37/143), breast carcinoma, 23.6% (103/437) and cervical cancer 23.3% (37/159). There is a significant proportion of DM2 among women with these four cancers, endometrial carcinoma being the highest followed by ovarian, breast and cervical carcinoma. The rising trend of these four cancers is in tandem with an increasing trend of DM2 in the community. In populations where diabetes is prevalent, screening for epithelial cancers should be rigourous. Diabetic clinics should include screening for these cancers among their female patients and gynecology clinics should screen the women they treat for their diabetes status.

Highlights

Kelantan is one of the states in Malaysia which has a high prevalence of type 2 diabetes (DM2)
To determine the proportion of breast, cervical, ovarian and endometrial cancers among females with Diabetes Mellitus Type 2 (DM2) diagnosed in Hospital Universiti Sains Malaysia (HUSM) over an 11 year period
There is a significant proportion of DM2 among women with these four cancers, endometrial carcinoma being the highest followed by ovarian, breast and cervical carcinoma

Summary

Introduction

A state in the north eastern region of Malaysia records the highest prevalence of diabetes in the country with overall prevalence at 10.5% and pre-diabetic state at 16.5% (Zaini, 2000). In a large prospective study in Japan, patients with DM2 are at increased risk of total cancers (Inoue et al, 2006a). Ovarian cancer risk is significantly high in patients who are diagnosed diabetes at age less than 30 years (Swerdlow et al, 2005). Epidemiological study shows that mortality rate for cancer patients with pre-existing diabetes is moderately increased compared to non diabetic patients (Vigneri et al, 2009). One large ppopulation-based cohort study in Sweden showed lack of an association between DM2 and ovarian cancer (Weiderpass et al, 2002). In view that Kelantan has high prevalence of obesity and diabetes, we wanted to investigate if breast, endometrial, cervical and ovarian carcinoma have association with DM2

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