Diabetes and risk of incident colorectal cancer in a prospective cohort of women

Andrew Flood, Lori Strayer, Catherine Schairer, Arthur Schatzkin

Research output: Contribution to journalArticlepeer-review

47 Scopus citations


Objective: To determine whether accounting for the time dynamics of diabetes exposure will change the risk estimates for colorectal cancer. Methods: We analyzed data from the 45, 516 women enrolled in the BCDDP follow-up cohort study. We used proportional hazards regression to obtain multivariable-adjusted risk estimates for incident colorectal cancer for prevalent diabetes at baseline and diabetes as a time-dependent variable. Results: Subjects with diabetes had a statistically significant increased risk of colorectal cancer compared to subjects without diabetes (RR = 1.60, 95% CI 1.18-2.18). When we defined exposure as duration of diabetes exposure at cohort exit, we found that in the first 4 years after diagnosis risk was essentially the same as in those never having had a diagnosis of diabetes. For those who had been diagnosed between 4 and 8 years previously, however, we observed a RR of 2.36 (95% CI 0.96-5.79), while longer duration of exposure was associated with smaller and then no change in risk compared to those without a diagnosis of diabetes. Conclusions: These results are consistent with the theory that hyperinsulinemia can explain, at least in part, the association of diabetes with colorectal cancer, but in a time-dependent manner.

Original languageEnglish (US)
Pages (from-to)1277-1284
Number of pages8
JournalCancer Causes and Control
Issue number8
StatePublished - Aug 2010

Bibliographical note

Funding Information:
Financial support Funding for this work was provided by National Institutes of Health (K07 CA108910-01A1 to A.F.) and Intramural Research Program funds from the National Cancer Institute, Bethesda, MD.


  • Cohort study
  • Colorectal cancer
  • Diabetes
  • Insulin
  • Time-dependent variable


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