4.3.0.0 Can­cer

Di­a­betes is as­so­ci­at­ed with in­creased risk of can­cers of the liver, pan­creas, en­dometri­um, colon/‍rectum, breast, and blad­der (29). The as­so­ci­a­tion may re­sult from shared risk fac­tors be­tween type 2 di­a­betes and can­cer (older age, obe­si­ty, and phys­i­cal inac­tiv­i­ty) but may also be due to di­a­betes-‍re­lat­ed fac­tors (30), such as un­der­ly­ing dis­ease phys­i­ol­o­gy or di­a­betes treat­ments, al­though ev­i­dence for these links is scarce. Pa­tients with di­a­betes should be en­cour­aged to un­der­go rec­om­mend­ed age- and sex- ap­pro­pri­ate can­cer screen­ings and to re­duce their modifiable can­cer risk fac­tors (obe­si­ty, phys­i­cal inac­tiv­i­ty, and smok­ing). New onset of atyp­i­cal di­a­betes (lean body habi­tus, neg­a­tive fam­i­ly his­to­ry) in a mid­dle-‍aged or older pa­tient may pre­cede the di­ag­no­sis of pan­cre­at­ic ade­no­car­ci­no­ma (31). How­ev­er, in the ab­sence of other symp­toms (e.g., weight loss, ab­dom­i­nal pain), rou­tine screen­ing of all such pa­tients is not cur­rently rec­om­mend­ed.