Head and Neck Cancers May Be More Prevalent in Patients with Diabetes Mellitus

AUGUST 04, 2014
Michael R. Page, PharmD, RPh
Researchers in Taiwan have found an increased risk for head and neck cancers among patients with diabetes mellitus.

Researchers Kuo-Shu Tseng, PhD, and colleagues at the Tainan University of Technology in Taiwan have identified an increased risk for head and neck cancer among patients with diabetes mellitus (DM).1
Using an insurance claims database, the researchers analyzed records from a total of 89,089 patients with a new diagnosis of DM. Each patient with DM was matched with a patient without a DM-related health claim.1
In patients with a new diagnosis of DM, head and neck cancer was 47% more likely to occur than in the control population, equating to a rate of 8.1 cases per 10,000 person-years in individuals with DM versus 5.5 cases per 10,000 person-years in patients without DM.1
In the population studied, head and neck cancer of the oral cavity was the most likely diagnosis, with an annual incidence (AI) of 0.41%, followed by nasopharyngeal cancer (AI: 0.11%) and oropharyngeal cancer (AI: 0.06%).1
In discussing the findings, the study authors concluded, “Because we adequately controlled for the confounding factors, our findings disclose a higher incidence of [head and neck cancer] in patients with DM and highlight the importance of monitoring patients with DM for [head and neck cancer].”1
Other studies have found similar associations between DM and head and neck cancer. In a 2012 metaanalysis by Stott-Miller et al, investigators pooled data from 12 studies comprising 6448 patients with head and neck cancer and 13,747 control patients.2
After adjusting for age, education level, sex, race/ethnicity, study center, cigarette smoking, alcohol use, and body mass index, the relationship between DM and head and neck cancer was not significant (odds ratio [OR], 1.09; 95% CI, 0.95–1.24).2
However, when analyzing data from patients with DM who had never smoked, investigators identified a significant 59% increase in the risk of developing head and neck cancer (OR, 1.59; 95% CI, 1.22–2.07).2
In a seemingly contradictory finding, a 2010 study by Gaudet et al found that the risk of head and neck cancer appeared to decline as body mass index increased in a multicountry registry study. The Gaudet study included data from 12,716 patients with head and neck cancer and 17,438 control patients. These findings were thought to be a result of weight loss associated with incident cases of head and neck cancer, rather than a true protective effect due to a higher body mass index.3
According to the National Cancer Institute, symptoms include a sore in the mouth or throat that does not heal, a persistent sore throat, difficulty swallowing, and hoarseness or voice changes.4
Considering that 2 metaanalyses show evidence of a relationship between DM and head and neck cancer, screening patients with DM for symptoms of head and neck cancer may help health care professionals detect cases earlier, which may enable more effective treatment.1,2
  1. Tseng K-S, et al. Increased risk for head, neck cancers in patients with diabetes [published online July 24, 2014]. JAMA Otolaryngol Head Neck Surg. 2014.
  2. Stott-Miller M, Chen C, Chuang SC, et al. History of diabetes and risk of head and neck cancer: a pooled analysis from the international head and neck cancer epidemiology consortium. Cancer Epidemiol Biomarkers Prev. 2012;21(2):294-304.
  3. Gaudet MM, Olshan AF, Chuang SC, et al. Body mass index and risk of head and neck cancer in a pooled analysis of case-control studies in the International Head and Neck Cancer Epidemiology (INHANCE) Consortium. Int J Epidemiol. 2010;39(4):1091-1102.
  4. Head and neck cancers. National Cancer Institute website.  www.cancer.gov/cancertopics/factsheet/Sites-Types/head-and-neck. Accessed July 2014.

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