Evaluation of Association of Diabetes Mellitus with Head and Neck Cancer: A Cross-Sectional Study

Malignant neoplasm is a major cause of death in developed countries, and its incidence continues to grow. Diabetes mellitus is a serious and leading health problem. Recent studies demonstrated that Diabetes mellitus (DM) was associated with a higher risk of Head and Neck Cancer (HNC). Only a few population-based studies, especially in Asian populations, have addressed these issues. Thus, this study aimed at assessing the relationship between Diabetes mellitus and Head and Neck Cancer (HNC) in reference to their socio-economic status. The present study was conducted on 483 HNC patients aged above 15 years. The data was collected from patients reporting to Mahavir Cancer Institute & Research Centre, Patna, and Rama Dental College Hospital and Research Center, Kanpur. Blood sugar level was tested to assess the status of diabetes mellitus. Results showed that of 483 patients, 70 patients (14.4%) had DM showing no overall relationship with HNC. A major number of HNC with DM was more in high socioeconomic status patients 41.7% (p<0.05), showing strong association whereas for low SES it was 3.4% (p>0.05). Diabetes was weakly associated with HNC, but evidence of a relationship with the socioeconomic group was observed.

KEYWORDS: Socioeconomic status, Diabetes mellitus, Head and Neck Cancer

1. WHO. Cancer. Available at: http://www.who.int/cancer/en/ Accessed 16.9.20
2. Basta G, Schmidt AM, De Caterina R. Advanced glycation end products and vascular inflammation: implications for accelerated atherosclerosis in diabetes. Cardiovasc Res. 2004;63(4):582–592.
3. Sasazuki S, Charvat H, Hara A, et al. Diabetes mellitus and cancer risk: pooled analysis of eight cohort studies in Japan. Cancer Sci. 2013;104(11):1499–1507.
4. Giovannucci E, Harlan DM, Archer MC, et al. Diabetes and cancer: a consensus report. Diabetes Care. 2010;33(7):1674–1685.
5. Giovannucci E, Harlan DM, Archer MC, et al. Diabetes and cancer: a consensus report. CA Cancer J Clin. 2010;60(4):207–221.
6. Stott-Miller M, Chen C, Schwartz SM. Type II diabetes and metabolic syndrome in relation to head and neck squamous cell carcinoma risk: a SEER-Medicare database study. Cancer Epidemiol. 2013;37(4):428–433.
7. 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.
8. Brownlee M. Biochemistry and molecular cell biology of diabetic complications. Nature. 2001;414(6865):813–820.
9. Adams TE, McKern NM, Ward CW. Signalling by the type 1 insulin-like growth factor receptor: interplay with the epidermal growth factor receptor. Growth Factors. 2004;22(2):89–95.
10. Valentinis B, Baserga R. IGF-I receptor signalling in transformation and differentiation. Mol Pathol. 2001;54(3):133–137.
11. Renehan AG, Zwahlen M, Minder C, O'Dwyer ST, Shalet SM, Egger M. Insulin-like growth factor (IGF)-I, IGF binding protein-3, and cancer risk: systematic review and meta-regression analysis. Lancet. 2004;363(9418):1346–1353.
12. Gonsalves MN, Jasphin S, Karkera B, Pandit S. Diabetes: risk factor for oral cancer?—A Review. Int J Adv Health Sci. 2015;1(1):25–28.
13. Cochrane L, Ellis IR, Islam MR, Jones SJ, Macluskey M. Activation of Akt at T308 and S473 in alcohol, tobacco, and HPV-induced HNSCC. Exp Hematol Oncol. 2014;3:25.
14. Mekala MR, Bangi BB, N J, et al. Association of Diabetes with Oral Cancer—an Enigmatic Correlation. Asian Pac J Cancer Prev. 2020;21(3):809–814.
15. Sasazuki S, Charvat H, Hara A, et al. Diabetes mellitus and cancer risk: pooled analysis of eight cohort studies in Japan. Cancer Sci. 2013;104(11):1499–1507.
16. Zhou XH, Qiao Q, Zethelius B, et al. Diabetes, prediabetes and cancer mortality. Diabetologia. 2010;53(9):1867–1876.
17. Wideroff L, Gridley G, Mellemkjaer L, et al. Cancer incidence in a population-based cohort of patients hospitalized with diabetes mellitus in Denmark. J Natl Cancer Inst. 1997;89(18):1360–1365.
18. 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.
19. Lo SF, Chang SN, Muo CH, et al. Modest increase in risk of specific types of cancer types in type 2 diabetes mellitus patients. Int J Cancer. 2013;132(1):182–188.
20. Tseng CH. Oral cancer in Taiwan: is diabetes a risk factor? Clin Oral Investig. 2013;17(5):1357–1364.
21. Stott-Miller M, Chen C, Schwartz SM. Type II diabetes and metabolic syndrome in relation to head and neck squamous cell carcinoma risk: a SEER-Medicare database study. Cancer Epidemiol. 2013;37(4):428–433.
22. APA. Socioeconomic Status. Available at: https://www.apa.org/topics/socioeconomic-status/ Accessed 19.9.20
23. Suwannaphant K, Laohasiriwong W, Puttanapong N, et al. Association between Socioeconomic Status and Diabetes Mellitus. J Clin Diagn Res. 2017;11(7):LC18–LC22.
24. Papaetis GS, Papakyriakou P, Panagiotou TN. Central obesity, type 2 diabetes and insulin: exploring a pathway full of thorns. Arch Med Sci. 2015;11(3):463–482.
25. Rooban T, Elizabeth J, Anusa R, Girish KG. Oral health hazards of chewing areca nut and products containing areca nut. Calicut Med J. 2005;3:e3.
26. Panchamukhi PR, Woolery T, Nayantara SN. Economics of bidis in India. In: Gupta PC, Asma S, editors. Bidi Smoking and Public Health. Ministry of Health and Family Welfare, Government of India; 2008. p. 167–195.
27. WHO. Tobacco Free Initiative. Global Adult Tobacco Survey (GATS) India report 2009–2010. Geneva: World Health Organization; 2011.
28. Corsi DJ, Subramanian SV. Divergent socioeconomic gradients in smoking by type of tobacco use in India. Int J Tuberc Lung Dis. 2014;18:122–124.
29. Madani A, H Dikshit M, Bhaduri D. Risk for oral cancer associated to smoking, smokeless and oral dip products. Indian J Public Health. 2012;56:57–60.
30. Balaram P, Sridhar H, Rajkumar T, et al. Oral cancer in southern India: The influence of smoking, drinking, paan-chewing and oral hygiene. Int J Cancer. 2002;98:440–445.
31. Znaor A, Brennan P, Gajalakshmi V, et al. Independent and combined effects of tobacco smoking, chewing and alcohol drinking on the risk of oral, pharyngeal and esophageal cancers in Indian men. Int J Cancer. 2003;105:681–686.
32. Wang P, Kang D, Cao W, Wang Y, Liu Z. Diabetes mellitus and risk of hepatocellular carcinoma: a systematic review and meta-analysis. Diabetes Metab Res Rev. 2012;28(2):109–122.
33. Shikata K, Ninomiya T, Kiyohara Y. Diabetes mellitus and cancer risk: review of the epidemiological evidence. Cancer Sci. 2013;104(1):9–14.
34. Verma M. Cancer control and prevention by nutrition and epigenetic approaches. Antioxid Redox Signal. 2012;17(2):355–364.
35. Jin Z, Feng X, Jian Q, et al. Aberrant methylation inactivation of the Ras-related associated with diabetes gene in human primary esophageal cancer. Anticancer Res. 2013;33(11):5199–5203.
36. Mo Y, Midorikawa K, Zhang Z, et al. Promoter hypermethylation of Ras-related GTPase gene RRAD inactivates a tumor suppressor function in nasopharyngeal carcinoma. Cancer Lett. 2012;323(2):147–154.
37. Sova P, Feng Q, Geiss G, et al. Discovery of novel methylation biomarkers in cervical carcinoma by global demethylation and microarray analysis. Cancer Epidemiol Biomarkers Prev. 2006;15(1):114–123.
38. Lee I, Yeom SY, Lee SJ, Kang WK, Park C. A novel senescence-evasion mechanism involving Grap2 and Cyclin D interacting protein inactivation by Ras associated with diabetes in cancer cells under doxorubicin treatment. Cancer Res. 2010;70(11):4357–4365.
39. Lee I, Yeom SY, Lee SJ, Kang WK, Park C. A novel senescence-evasion mechanism involving Grap2 and Cyclin D interacting protein inactivation by Ras associated with diabetes in cancer cells under doxorubicin treatment. Cancer Res. 2010;70(11):4357–4365.
40. Turturro F, Friday E, Welbourne T. Hyperglycemia regulates thioredoxin-ROS activity through induction of thioredoxin-interacting protein (TXNIP) in metastatic breast cancer-derived cells MDA-MB-231. BMC Cancer. 2007;7:96.