SUNDAY, Dec. 8, 2013 (HealthDay News) -- People with type 2
diabetes might be at somewhat higher risk of developing liver
cancer, according to a large, long-term study.
The research suggests that those with type 2 diabetes have about
two to three times greater risk of developing hepatocellular
carcinoma (HCC) -- the most common type of liver cancer -- compared
to those without diabetes.
Still, the risk of developing liver cancer remains low, experts
Race and ethnicity might also play a role in increasing the odds
of liver cancer, the researchers said.
An estimated 26 percent of liver cancer cases in Latino study
participants and 20 percent of cases in Hawaiians were attributed
to diabetes. Among blacks and Japanese-Americans, the researchers
estimated 13 percent and 12 percent of cases, respectively, were
attributed to diabetes. Among whites, the rate was 6 percent.
"In general, if you're a [type 2] diabetic, you're at greater risk of liver cancer," said lead author V. Wendy Setiawan, an assistant professor at the Keck School of Medicine at the University of Southern California.
Yet the actual risk of liver cancer -- even for those with type
2 diabetes -- is still extraordinarily low, said Dr. David
Bernstein, chief of hepatology at North Shore University Hospital
in Manhasset, N.Y.
Although liver cancer is relatively rare, it has been on the
rise worldwide and often is associated with viral hepatitis
infections and liver diseases, such as cirrhosis.
New cases of HCC in the United States have tripled in the past
30 years, with Latinos and blacks experiencing the largest
increase, Setiawan said. During that time, type 2 diabetes also has
become increasingly common.
What might the connection be?
It's possible that the increased risk of liver cancer could be
associated with the medications people with diabetes take to
control their blood sugar, said Dr. James D'Olimpio, an oncologist
at Monter Cancer Center in Lake Success, N.Y. "Some medications are
known to inhibit normal suppression of cancer," he said.
"Some of the drugs already have [U.S. Food and Drug Administration-ordered] black box warnings for bladder cancer," D'Olimpio said. "It's not a stretch to think there might be other relationships between diabetes drugs and pancreatic or liver cancer. Diabetes is already associated with a high risk of developing pancreatic cancer."
People with type 2 diabetes often develop a condition called
"fatty liver," D'Olimpio said. In these cases, the liver has
trouble handling the abundance of fat in its cells and gradually
becomes inflamed. That situation can trigger a cascade of problems,
including cirrhosis (a chronic disease of the liver), fibrosis
(thickening and scaring of tissue) and, ultimately, cancer, he
D'Olimpio said fatty liver disease is the No. 1 cause of HCC.
"[Type 2] diabetics have twice the chance of having a fatty liver,
at least," he said. "If you're an African-American or Latino, that
may make you even more susceptible."
People with type 1 diabetes, however, do not have an increased
risk of liver cancer, he said.
The new research is scheduled for presentation Sunday at an
American Association for Cancer Research meeting in Atlanta. The
data and conclusions should be viewed as preliminary until
published in a peer-reviewed journal.
The study analyzed data collected between 1993 and 1996 from
nearly 170,000 black, Native Hawaiian, Japanese-American, Latino
and white adults. Researchers followed up with the participants
about 16 years after they had answered a comprehensive health
questionnaire. Over that time, about 500 participants had developed
Information about risk factors -- such as age, whether they had
type 2 diabetes, alcohol intake, body-mass index (a measure of body
fat) and cigarette smoking -- was analyzed, and blood tests for
hepatitis B and hepatitis C were performed on about 700 of the
participants, with and without liver cancer.
Whether people smoked or drank alcohol did not appear to change
the relationship between having diabetes and getting liver cancer,
the researchers said.
Although the study found an association between having type 2
diabetes and developing liver cancer, it did not prove a
North Shore's Bernstein urged caution in interpreting the
results. "It's a single study that talks about a large number of
people with a common disease like diabetes and links it to liver
cancer," he said. "We have a lot more learning to do and more work
is needed to prove an association and define what the risk really
A study this month by the American Diabetes Association showed
that many Americans are unaware that they are at risk for type 2
diabetes. D'Olimpio urged people to get the simple blood test,
called fasting blood sugar, to test for diabetes.
The next step is to learn what role genetics may play in whether
an individual with type 2 diabetes will develop liver cancer, study
author Setiawan said.
Learn more about liver cancer from the
U.S. National Library of Medicine.
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