Diabetes again linked to colon cancer risk

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By Amy Norton

NEW YORK | Wed Sep 28, 2011 3:33pm EDT

NEW YORK (Reuters Health) - A new research review confirms that people with diabetes have a somewhat increased risk of colon cancer -- but the reasons for the connection, and what should be done about it, remain unclear.

Combining the results of 14 international studies, researchers found that overall, people with diabetes were 38 percent more likely to be diagnosed with colon cancer than those who were diabetes-free.

There was also a 20 percent increase in the risk of rectal cancer, though that appeared to be confined to men.

The findings, reported in the American Journal of Gastroenterology, do not prove that diabetes directly contributes to colon cancer in some people.

The results come from observational studies in which people with diabetes were found to have a higher risk of colon cancer than those without diabetes. In most of the studies, the researchers adjusted for at least some factors that might explain the link -- like older age, obesity and smoking -- and the diabetes-cancer connection remained.

However, there could still be other explanations.

"I think we can make the statement that diabetes is consistently associated with colorectal cancer," Dr. Edward Giovannucci of the Harvard School of Public Health, who was not involved the study, told Reuters Health in an email.

"The cause-and-effect aspect is a bit difficult to consider since diabetes is such a complex disease," said Giovannucci, who studies the underlying causes of colon cancer.

He said it seems likely that some aspect of diabetes contributes to colon cancer, but it's not certain what.

One theory is that hormones are involved.

People with diabetes tend to have high levels of the blood-sugar-regulating hormone insulin, as well as related hormones called insulin-like growth factors. Those hormones cause cells to grow and spread, and that may include cancer cells.

Whatever the mechanism, if diabetes does contribute to colon cancer, it's not clear what the implications would be.

People with diabetes are not advised to get colon cancer screening any more often, or at a younger age, than people without diabetes, said Dr. Hiroki Yuhara, who led the new study while based at the University of California, Berkeley.

And it's not clear if that advice will change at any time in the future, Yuhara told Reuters Health in an email.

Experts recommend that most people start colon cancer screening at the age of 50, with any of several tests -- including stool tests that look for hidden blood, or invasive tests like sigmoidoscopy or colonoscopy.

People with certain risk factors for colon cancer -- like inflammatory bowel disease (Crohn's disease or colitis) or a strong family history of the cancer -- are told to start screening earlier. Diabetes is not currently considered one of those risk factors.

And there's evidence that the link between diabetes and colon cancer risk may be weakening.

A study published last year by researchers at the American Cancer Society (ACS) found that among more than 184,000 older Americans followed for 15 years, men with type 2 diabetes were about one-quarter more likely to be diagnosed with colon cancer than diabetes-free men were.

But that increase in risk was modest and, the researchers said, smaller than past studies had suggested.

What's more, there was no similar increase seen among women with type 2 diabetes. (The study was not included in the current analysis, which considered studies published from the 1990s through 2009, from the U.S., Canada, Europe and Japan.)

The ACS researchers speculated that the findings might reflect better diabetes control among Americans -- and women, in particular -- in recent years. A separate government study had shown that U.S. women with diabetes improved their long-term blood sugar control between 1999 and 2004.

In theory, better blood sugar control would mean lower insulin levels, which might affect colon cancer risk.

But that's speculation. For now, Giovannucci recommended that people focus on maintaining a healthy weight and getting regular exercise: Obesity is a risk factor for both diabetes and colon cancer.

According to Yuhara, people with diabetes should be aware of the link to colon cancer risk, and follow their doctors' advice on screening for the cancer.

It's estimated that just over 101,000 Americans will be diagnosed with colon cancer in 2011, while almost 40,000 will be told they have rectal cancer, according to the ACS. The average American has about a 1 in 20 lifetime chance of developing either cancer.

SOURCE: bit.ly/qJa6tK American Journal of Gastroenterology, online September 13, 2011.

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Diabetes again linked to colon cancer risk: study

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n">(Reuters) - People with diabetes have a somewhat increased risk of colon cancer, an international study said -- but the reasons for the connection, and what should be done about it, remain unclear.

Researchers headed by Hiroki Yuhara, at the University of California, Berkeley, combined the results of 14 international studies and found that, overall, people with diabetes were 38 percent more likely to be diagnosed with colon cancer than those who were diabetes-free.

There was also a 20 percent increase in the risk of rectal cancer, though that appeared to be confined to men, according to the findings, published in the American Journal of Gastroenterology.

"These data suggest that diabetes mellitus is an independent risk factor for colon and rectal cancer," Yuhara and his colleagues wrote.

The findings do not prove that diabetes directly contributes to colon cancer in some people.

The results come from observational studies in which people with diabetes were found to have a higher risk of colon cancer than those without diabetes. In most of the studies, the researchers adjusted for at least some factors that might explain the link -- like older age, obesity and smoking -- and the diabetes-cancer connection remained.

"I think we can make the statement that diabetes is consistently associated with colorectal cancer," said Edward Giovannucci of the Harvard School of Public Health, who was not involved in the study.

"The cause-and-effect aspect is a bit difficult to consider since diabetes is such a complex disease," he told Reuters Health in an email.

He said it seems likely that some aspect of diabetes contributes to colon cancer, but it's not certain what.

One theory is that hormones are involved.

People with Diabetes tend to have high levels of the blood-sugar-regulating hormone insulin, as well as related hormones called insulin-like growth factors. Those hormones cause cells to grow and spread, and that may include cancer cells.

If diabetes does contribute to colon cancer, it's not clear what the implications would be.

People with diabetes are not advised to get colon cancer screening any more often, or at a younger age, than people without diabetes, said Yuhara.

It's also not clear if that advice will change at any time in the future. Experts recommend that most people start colon cancer screening at the age of 50.

People with certain risk factors for colon cancer, such as a strong family history of the cancer, are told to start screening earlier. Diabetes is not currently considered one of those risk factors.

And there's evidence the link between diabetes and colon cancer risk may be weakening.

A study published last year by researchers at the American Cancer Society (ACS), and not included in the current analysis, found that among the 184,000 older U.S. residents followed for 15 years, men with type 2 diabetes were about one-quarter more likely to be diagnosed with colon cancer than diabetes-free men were.

But that increase in risk was modest, and smaller than past studies had suggested. In addition, there was no similar increase seen among women with type 2 diabetes.

The ACS researchers speculated that the findings might reflect better diabetes control among U.S. residents -- and women in particular -- in recent years. In theory, better blood control would mean lower insulin levels, which might affect colon cancer risk.

For now, Giovannucci recommended that people focus on maintaining a healthy weight and getting regular exercise.

The analysis included studies published from the 1990s through 2009, from the United States, Canada, Europe and Japan. SOURCE: bit.ly/qJa6tK

(Reporting from New York by Amy Norton at Reuters Health; editing by Elaine Lies)

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Nyad will not attempt crossing again

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Third time not charm for Diana NyadSwimmer Diana Nyad says she will not attempt Cuba-to-Florida crossing againNyad says toxic jellyfish are too much to overcome"It's not easy for me to let go of this dream," she said

(CNN) -- With no way to counter toxic jellyfish that brought intense pain and partial paralysis during an attempted 103-mile ocean crossing from Cuba to Florida, endurance swimmer Diana Nyad said Monday that she will not make another attempt at the feat.

"I can't beat those guys. They're too much for me," Nyad said.

Nyad, 62, swam 82 nautical miles of the 103-mile crossing before two stings from what her team identified as potentially lethal box jellyfish forced her out of the water Sunday morning.

In a frequently emotional news conference in which she removed her shirt to reveal sting marks, Nyad said she initially planned to muscle through the intense pain. But she said she eventually had to give up as the toxins began to cause partial paralysis and made it increasingly difficult for her to breathe.

What's a Portuguese man-of-war?

Nyad still had a wheeze Monday, said one of her doctors, Clifton Page of the University of Miami.

Toxins from the stings also affected members of her crew trying to help her.

"This was a life-threatening situation we were in," Page said.

Nyad stopped the swim Sunday morning after 40 hours in the water.

"It's not easy for me to let go of this dream, and I'm in distress about it," she said.

She said it was "naive" of her not to anticipate problems from the jellyfish, which she said are proliferating throughout the world's oceans because of climate change. Unlike sharks, which her team countered with divers and electronic devices, no good tools exist to fend off jellyfish, Nyad said.

She said she knows she could complete the crossing were it not for the creatures. She said the last two years of training were not wasted.

"It's been a grand, elevating, life-confirming experience these last two years," she said.

Nyad began her attempt Friday evening from Havana's Hemingway Marina, expecting to spend about 60 hours in the water.

It was her third attempt to complete the swim.

Her first, in 1978, was brought to an end by strong currents and bad weather after almost 42 hours in the water.

She made a second try in August, but she was pulled from the water after 60 miles and almost 29 hours of swimming. She blamed a shoulder injury she suffered early in the journey and an 11-hour-long asthma attack.

She said people inspired by her efforts should continue to train their bodies, test their wills and dream big. And, said said, not being able finish the crossing against such odds was no sign of failure, for her or her team.

"There's so much boldness in living life this way, and we did it all, and no one can take it away from us," she said.

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Bacteria Show Up in Hospital Rooms, Again

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We get it — hospitals are crawling with germs. If it's not your cell phone, the doctor's coat or even the hands-free water faucet, then it's the privacy curtain around the bed that's tainted with unwanted bacteria.

Researchers from the University of Iowa presented data at a scientific conference in Chicago this week showing that they had found disease-causing bugs, including drug-resistant varieties like MRSA (methicillin-resistant Staphylococcus aureus) and VRE (vancomycin-resistant enterococcus), on 95% of hospital room privacy curtains tested. Brand new curtains were contaminated within a week, the researchers said.

The team tested 43 curtains in 30 hospital rooms twice a week for three weeks, taking 180 swab cultures total. They found:

12 of 13 new curtains were contaminated within 7 days41 of 43 curtains were contaminated on at least one occasionMRSA was found on 21% of curtainsVRE was found on 42% of curtains

One of the authors of the study received consulting fees from PurThread Technologies, a company that makes antimicrobial fabrics for hospitals — including, hey, privacy curtains.

Luckily, there's an easier and cheaper way for doctors to prevent the spread of disease-causing bacteria from curtains (or anywhere) to patients: by washing their hands.

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