Cancer risk associated with chronic diseases and disease markers: prospective cohort study
BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k134 (Published 31 January 2018) Cite this as: BMJ 2018;360:k134
- Huakang Tu, postdoctoral fellow1,
- Chi Pang Wen, professor and investigator2 3 4,
- Shan Pou Tsai, professor and epidemiologist5,
- Wong-Ho Chow, professor1,
- Christopher Wen, radiologist6,
- Yuanqing Ye, assistant professor1,
- Hua Zhao, associate professor1,
- Min Kuang Tsai, research assistant2,
- Maosheng Huang, senior statistical analyst1,
- Colin P Dinney, professor7,
- Chwen Keng Tsao, chairman8,
- Xifeng Wu, professor1
- 1Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
- 2Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
- 3Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan
- 4Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
- 5MJ Health Research Foundation, Taipei, Taiwan
- 6Radiology, Long Beach Veterans Administration Hospital, University of California at Irvine, CA, USA
- 7Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- 8MJ Health Management Institution, Taipei, Taiwan
- Correspondence to: X Wu xwu{at}mdanderson.org
- Accepted 11 December 2017
Abstract
Objectives To assess the independent and joint associations of major chronic diseases and disease markers with cancer risk and to explore the benefit of physical activity in reducing the cancer risk associated with chronic diseases and disease markers.
Design Prospective cohort study.
Setting Standard medical screening program in Taiwan.
Participants 405 878 participants, for whom cardiovascular disease markers (blood pressure, total cholesterol, and heart rate), diabetes, chronic kidney disease markers (proteinuria and glomerular filtration rate), pulmonary disease, and gouty arthritis marker (uric acid) were measured or diagnosed according to standard methods, were followed for an average of 8.7 years.
Main outcome measures Cancer incidence and cancer mortality.
Results A statistically significantly increased risk of incident cancer was observed for the eight diseases and markers individually (except blood pressure and pulmonary disease), with adjusted hazard ratios ranging from 1.07 to 1.44. All eight diseases and markers were statistically significantly associated with risk of cancer death, with adjusted hazard ratios ranging from 1.12 to 1.70. Chronic disease risk scores summarizing the eight diseases and markers were positively associated with cancer risk in a dose-response manner, with the highest scores associated with a 2.21-fold (95% confidence interval 1.77-fold to 2.75-fold) and 4.00-fold (2.84-fold to 5.63-fold) higher cancer incidence and cancer mortality, respectively. High chronic disease risk scores were associated with substantial years of life lost, and the highest scores were associated with 13.3 years of life lost in men and 15.9 years of life lost in women. The population attributable fractions of cancer incidence or cancer mortality from the eight chronic diseases and markers together were comparable to those from five major lifestyle factors combined (cancer incidence: 20.5% v 24.8%; cancer mortality: 38.9% v 39.7%). Among physically active (versus inactive) participants, the increased cancer risk associated with chronic diseases and markers was attenuated by 48% for cancer incidence and 27% for cancer mortality.
Conclusions Chronic disease is an overlooked risk factor for cancer, as important as five major lifestyle factors combined. In this study, chronic diseases contributed to more than one fifth of the risk for incident cancer and more than one third of the risk for cancer death. Physical activity is associated with a nearly 40% reduction in the cancer risk associated with chronic diseases.
Footnotes
Contributors: HT and CPW contributed equally to this study. XW, CPW, and HT conceived and designed the study. CKT collected, assembled, and quality controlled the data. MH, HT, CPW, XW, SPT, YY, and MKT analyzed and interpreted the data. HT, CPW, and XW drafted the first version of the report. All authors contributed to the content and critical revision of the report and agreed to submit the report for publication. XW is the guarantor.
Funding: This study was supported by NCI R01 CA170298 to XW, NCI R01 CA180083 to XW, Center for Transnational and Public Health Genomics at MD Anderson Cancer Center, and in part by Taiwan Ministry of Health and Welfare Clinical Trial Center (MOHW107-TDU-B-212-123004). The funding source had no role in study design, data collection, data analysis, data interpretation, writing of the report, or the decision to submit the paper for publication. XW had full access to all the data in the study and had final responsibility for the decision to submit for publication.
Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.
Ethical approval: Informed consent was obtained to authorize data processing and analysis. Ethical reviews were approved by the Institutional Review Boards at the National Health Research Institutes (Taiwan). Individually identifying data were removed and remained anonymous during the entire study.
Data sharing: No additional data available.
Transparency: The lead author (XW) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.
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