Cancer risk associated with chronic diseases and disease markers: prospective cohort study

• Published in: BMJ (Online) 2018-01, Vol.360, p.k134-k134
• Main Authors: Tu, Huakang, Wen, Chi Pang, Tsai, Shan Pou, Chow, Wong-Ho, Wen, Christopher, Ye, Yuanqing, Zhao, Hua, Tsai, Min Kuang, Huang, Maosheng, Dinney, Colin P, Tsao, Chwen Keng, Wu, Xifeng
• Format: Article
• Language: English
• Subjects: Adult; Alzheimer's disease; Arthritis; Arthritis, Gouty - epidemiology; Arthritis, Gouty - metabolism; Biomarkers - blood; Blood pressure; Cancer; Cardiovascular disease; Cardiovascular Diseases - complications; Cardiovascular Diseases - epidemiology; Cholesterol; Chronic Disease - epidemiology; Chronic Disease - mortality; Chronic illnesses; Cohort analysis; Data collection; Diabetes; Diabetes Complications; Diabetes mellitus; Diabetes Mellitus - epidemiology; Disease prevention; Early Detection of Cancer - methods; Exercise; Exercise - physiology; Family medical history; Fasting; Female; Glomerular filtration rate; Health risk assessment; Heart rate; Humans; Hypertension; Incidence; Kidney diseases; Life Style; Lifestyles; Lung diseases; Lung Diseases - epidemiology; Lung Diseases - metabolism; Lung Diseases - physiopathology; Male; Medical screening; Metabolism; Middle Aged; Mortality; Neoplasms - complications; Neoplasms - epidemiology; Neoplasms - mortality; Nutrition research; Outcome Assessment (Health Care); Physical activity; Physical fitness; Population; Prospective Studies; Proteinuria; Renal Insufficiency, Chronic - complications; Renal Insufficiency, Chronic - epidemiology; Risk Factors; Taiwan - epidemiology; Uric acid
• ISSN: 0959-8138; 1756-1833
• DOI: 10.1136/bmj.k134

AbstractObjectivesTo 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.DesignProspective cohort study.SettingStandard medical screening program in Taiwan.Participants405 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 measuresCancer incidence and cancer mortality.ResultsA 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.ConclusionsChronic 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% red