糖尿病與癌症之關聯以及台灣現況探討

Relationship between Diabetes and Cancer and the Situation in Taiwan

沈宜靜(Yi-Jing Sheen) ； 林建良(Jiann-Liang Lin) ； 許惠恒(Wayne Huey-Herng Sheu)

《內科學誌》 22卷1期 (2011/02) Pp. 19-30

https://doi.org/10.6314/JIMT.2011.22(1).03

摘要

糖尿病與癌症是全球性的重大健康議題。2009年台灣十大死因中，癌症已蟬連十大死因之首28年，而糖尿病也高居第五名，且兩者的死亡率仍持續上升。流行病學資料顯示糖尿病可能是影響癌症發生與預後之風險因子。推測原因包括高胰島素血症、高血糖、炎症反應及共同危險因素，如：老化、飲食、運動與肥胖等。在糖尿病用藥方面，有些證據顯示使用雙胍類藥物罹癌風險較低，但特定藥物對癌症風險的影響證據有限。統合性資料分析(meta-analysis)指出糖尿病可能增加肝、胰、子宮內膜、結腸直腸癌、乳癌、膀胱癌風險，但罹患攝護腺癌的風險似乎較低。根據台灣相關研究，與糖尿病呈正相關的有大腸直腸癌、肝癌、膽道癌、乳癌、膀胱癌、非何杰金淋巴癌以及口腔麟狀細胞癌，且乳癌、膀胱癌的死亡率在年輕糖尿病患相對風險更高。糖尿病相關癌症與一般族群略有不同，未來應根據國內相關研究結果，建議糖尿病患依其年齡與性別接受適當的癌症篩檢，以早期發現早期治療。

關鍵字

糖尿病 ； 癌症

並列摘要

Both diabetes and cancer are major global health issues. In Taiwan, cancer has been the first leading cause of death in the past decades, whereas diabetes was recently ranked as the fifth leading cause of death. Epidemiologic evidence suggests that patients with diabetes are at a high risk of developing cancer and have poor cancer prognosis. These 2 diseases share several common risk factors such as aging, diet, physical activity, and obesity. The following underlying mechanisms have been reported to be associated with these 2 diseases: hyper-insulinemia, hyperglycemia, and inflammation. Previous studies showed that biguanides are associated with a low risk of cancer, but evidence for the effects of other specific hypoglycemic drugs on cancer risk is limited. Studies that included meta-analysis showed that several cancers are highly associated with diabetes: cancer of the liver, pancreas, endometrium, colon and rectum, breast, and bladder. However, diabetes was found to be associated with a low risk of prostate cancer. Results of epidemiological studies from Taiwan showed that diabetes is associated with increased risk of colon and rectal cancer, liver and bile duct cancer, pancreatic cancer, breast cancer, bladder cancer, non-Hodgkin lymphoma, and oral squamous cell carcinoma. In addition, young patients with diabetes were at a high risk of mortality from breast and bladder cancer. Further research is needed to clarify the association between these 2 diseases in Taiwan. From the literature, we recommend that diabetic patients undergo appropriate cancer screenings according to their age and gender.

並列關鍵字

Diabetes mellitus ； Cancer