Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.
Statistics and Data Analysis, Danish Cancer Society Research Center, Copenhagen, Denmark.
Int J Cancer. 2021 May 1;148(9):2090-2101. doi: 10.1002/ijc.33365. Epub 2020 Nov 9.
In this register-based cohort study, we estimated the incidence of human papillomavirus (HPV)-related anogenital precancer and cancer in women with diabetes compared with women without diabetes. We followed all women living in Denmark born 1916 to 2001 (n = 2 508 321) for individual-level information on diabetes (Type 1 or 2 [T1D or T2D]), diagnoses of cervical, vaginal, vulvar and anal intraepithelial neoplasia Grade 2 or 3 (IN2/3) and cancer and other covariates from nationwide registries. We used Poisson regression to model the incidence rates of anogenital IN2/3 and cancer as a function of diabetes status, age, HPV vaccination, education, calendar year, and cervical cancer screening status. Incidence rate ratios (IRRs) were estimated for diabetes overall, and separately for T1D and T2D, compared with women without diabetes. Women with diabetes had higher rates of vulvar IN2/3 (IRR = 1.63; 95% confidence interval [CI]: 1.41-1.88), vulvar cancer (IRR = 1.61; 95% CI: 1.36-1.91) and vaginal cancer (IRR = 1.79; 95% CI: 1.27-1.91) than women without diabetes. Similar patterns were observed for anal IN2/3, anal cancer and cervical cancer, although not statistically significant. In contrast, women with diabetes had lower rates of cervical IN2/3 (IRR = 0.74; 95% CI: 0.69-0.79) than women without diabetes. Patterns were generally similar in women with T1D and T2D, although cancer rates were higher in women with T2D. In conclusion, the incidence of most anogenital precancers and cancers were increased in women with diabetes. However, women with diabetes had lower incidence of cervical precancer. Our findings could be explained by biological mechanisms and/or behavioral factors, such as smoking and less frequent cervical screening participation.
在这项基于登记的队列研究中，我们估计了与无糖尿病女性相比，糖尿病女性中与人类乳头瘤病毒（HPV）相关的肛门生殖器癌前病变和癌症的发病率。我们对所有丹麦出生于 1916 年至 2001 年的女性（n=2508321 人）进行了个体层面的信息随访，包括糖尿病（1 型或 2 型[T1D 或 T2D]）、宫颈、阴道、外阴和肛门上皮内瘤变 2 级或 3 级（IN2/3）及癌症等诊断信息，这些信息来源于全国性登记处。我们使用泊松回归模型，将肛门生殖器 IN2/3 和癌症的发病率作为糖尿病状态、年龄、HPV 疫苗接种、教育、日历年份和宫颈癌筛查状态的函数进行建模。针对糖尿病总体，以及与无糖尿病女性相比，1 型糖尿病和 2 型糖尿病，我们分别计算了发病率比值比（IRR）。与无糖尿病女性相比，糖尿病女性的外阴 IN2/3（IRR=1.63；95%置信区间[CI]：1.41-1.88）、外阴癌（IRR=1.61；95%CI：1.36-1.91）和阴道癌（IRR=1.79；95%CI：1.27-1.91）的发病率更高。对于肛门 IN2/3、肛门癌和宫颈癌，也观察到了类似的模式，尽管没有统计学意义。相反，与无糖尿病女性相比，糖尿病女性的宫颈 IN2/3（IRR=0.74；95%CI：0.69-0.79）发病率更低。在 1 型糖尿病和 2 型糖尿病女性中，模式基本相似，尽管 2 型糖尿病女性的癌症发病率更高。总之，糖尿病女性的大多数肛门生殖器癌前病变和癌症的发病率都有所增加。然而，糖尿病女性的宫颈癌前病变发病率较低。我们的研究结果可能可以用生物学机制和/或行为因素来解释，如吸烟和较少参加宫颈癌筛查。
