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P Vigneri, Department of Biomedical Sciences, Section of General Pathology, University of Catania, Catania, Italy
F Frasca, Department of Internal and Specialistic Medicine, Section of Endocrinology, University of Catania, Catania, Italy
L Sciacca, Department of Internal and Specialistic Medicine, Section of Endocrinology, University of Catania, Catania, Italy
G Pandini, Department of Internal and Specialistic Medicine, Section of Endocrinology, University of Catania, Catania, Italy
R Vigneri, Internal Medicine, Endocrinology, Catania, 95122, Italy

Correspondence: Riccardo Vigneri, Email: vigneri{at}unict.it

Abstract

Diabetes and Cancer are two heterogeneous, multifactorial, severe and chronic diseases. Because of their frequency, reciprocal influences, even if minor, may have a major impact.

Epidemiological studies clearly indicate that the risk for several types of cancer (including pancreas, liver, breast, colorectal, urinary tract and female reproductive organs) is increased in diabetic patients. Mortality is also moderately increased.

Several confounding factors, having general or site-specific relevance, make it difficult to accurately assess cancer risk in diabetic patients. These factors include diabetes duration, varying levels of metabolic control, different drugs used for therapy and the possible presence of chronic complications. Hyperinsulinemia most likely favors cancer in diabetic patients as insulin is a growth factor with preeminent metabolic but also mitogenic effects and its action in malignant cells is favored by mechanisms acting both at the receptor and post-receptor level. Obesity, hyperglycemia and increased oxidative stress may also contribute to increased cancer risk in diabetes.

While antidiabetic drugs have a minor influence on cancer risk (except perhaps the biguanide metformin that apparently reduces the risk), drugs used to treat cancer may either cause diabetes or worsen a pre-existing diabetes. In addition to the well-known diabetogenic effect of glucocorticoids and antiandrogens, an increasing number of targeted anti-cancer molecules may interfere with glucose metabolism acting at different levels on the signaling substrates shared by IGF-I and insulin receptors.

In conclusion, diabetes and cancer have a complex relationship that requires more clinical attention and better-designed studies.

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