Implications for Practice
The AACE/ACE statement6 offers several recommendations for clinicians:
- Cancer screening and counseling on lifestyle changes should be part of regular preventive care in people with obesity and/or diabetes.
- Individuals who develop “typical” obesity-related cancers, especially at a young age, should be screened for metabolic abnormalities (eg, insulin resistance, metabolic syndrome, diabetes, cardiovascular disease).
- Begin cancer screening tests (eg, for breast, colon, and skin cancers) earlier in at-risk individuals.
- Lifestyle changes (eg, weight loss, exercise) are as important in cancer as in diabetes and obesity.
- Clinicians should not change their current practice until further research is conducted. However, clinicians should be alert to potential risk, monitor patients closely, and engage in a risk-benefit analysis, balancing out cancer risk against suboptimal glycemic control and ensuing cardiovascular complications.
- Short exposure to new medication is unlikely to result in cancer, which typically takes many years to develop; however, growth of a previously initiated cancer could be accelerated by antihyperglycemic medications.
- Aggressive glycemic management has been associated with improved outcomes in diabetic inpatients who are undergoing treatment for malignancies.
- While metformin may be protective against cancer, it should not be used for this unproven indication.
Garg et al conclude that “joint management and reduction of diabetes, cancer, and obesity is likely to result in greater improvement in mortality than treating these diseases separately. Consequently, a multidisciplinary approach is needed to uncover the mechanisms underlying the associations between these diseases and, ultimately, improve clinical outcomes.”3
1. Giovannucci E, Harlan DM, Archer MC, et al. Diabetes and cancer: a consensus report. Diabetes Care 2010;33:1674–1685.
2. Sun G, Kashyap SR. Cancer risk in type 2 diabetes mellitus: metabolic links and therapeutic considerations. J Nutr Metab.2011;2011:708183.
3. Garg SK, Maurer H, Reed K, Selagamsetty R. Diabetes and cancer: two diseases with obesity as a common risk factor.Diabetes Obes Metab. 2014;16(2):97-110.
4. Kellenberger LD, Bruin JE, Greenaway J, et al. The role of dysregulated glucose metabolism in epithelial ovarian cancer. J Oncol.2010;2010:514310.
5. van Kruijsdijk RC, van der Wall E, Visseren FL. Obesity and cancer: the role of dysfunctional adipose tissue. Cancer Epidemiol Biomarkers Prev. 2009;18(10):2569-2578.
6. Handelsman Y, Leroith D, Bloomgarden ZT, et al. Diabetes and cancer—an AACE/ACE consensus statement.Endocr Pract. 2013;19(4):675-693.
7. Egan AG, Blind E, Dunder K, et al. Pancreatic Safety of Incretin-Based Drugs—FDA and EMA Assessment. N Engl J Med 2014;370(9):794-797.