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Press release of the German Cancer Research Center (DKFZ) with a supplement by the NCT Heidelberg

Preventing diabetes means preventing cancer

On the occasion of World Diabetes Day on November 14, the German Cancer Research Center (DKFZ) will inform about the connections between cancer and diabetes - and why a healthy lifestyle can reduce the risk of both serious diseases at the same time.

 Diabetes type 2 is on the rise worldwide: According to the WHO, in 1980 around 108 million people were affected by the severe metabolic disease, by 2014 the figure had risen to 422 million. The number of diabetics is rising particularly sharply in the emerging markets. In Germany, around 500,000 people are diagnosed with diabetes for the first time every year.

 Numerous epidemiological studies have confirmed over the last few years that diabetics have a significantly increased risk of developing cancer. A meta-analysis by Australian scientists* showed in 2018 that the cancer risk of male diabetics is 19 percent higher than the risk of the general population, and for female diabetics even 27 percent. In a recent publication**, scientists from the DKFZ and the National Center for Tumor Diseases (NCT) Heidelberg prove this correlation for colorectal cancer, especially for diseases in younger age groups. 

 But how can type 2 diabetes influence the development of cancer? Today, experts assume that the risk of cancer is increasing even before type 2 diabetes has even been diagnosed: In many cases, the actual "diabetes" is preceded by a metabolic derailment, which is known as the metabolic syndrome. The syndrome is characterized by four main features: obesity, especially in the abdominal area, as well as misregulated blood lipids, elevated blood pressure and elevated blood sugar, often already associated with insulin resistance.

 "With the metabolic syndrome, we therefore also speak of the deadly quartet," says Mathias Heikenwälder, metabolic expert from the DKFZ, and continues: "Abdominal fat is particularly dangerous in terms of cancer development. This is because this fatty tissue releases messenger substances into the environment that trigger inflammatory reactions and reduce the effect of insulin, so-called adiponectins and cytokines. Some of these messenger substances also act as growth factors. They stimulate other cells to divide and thus also promote tumor growth. In addition, the fat cells produce estrogens, which can stimulate cell growth in hormone-sensitive tissue of the breast and uterus.

 If the metabolic syndrome persists for years, type 2 diabetes can develop. Other frequent secondary diseases are arteriosclerosis, heart attacks, strokes - and cancer.

However, the serious health consequences of the metabolic syndrome can be averted - an adjustment in lifestyle can halt the pathological development. "Nutrition and exercise are the levers that sufferers have to use," says Susanne Weg-Remers, head of the Cancer Information Service at the DKFZ.

First of all, this means eating a conscious and balanced diet, with a balanced energy balance. Regular physical exercise, preferably 30 minutes a day, is just as important. Exercise increases energy consumption and thus helps to lose excess weight. However, Weg-Remers also knows how difficult it is for most people to get rid of years of unhealthy habits. "But it is worth it: If you take timely and consistent countermeasures, you can significantly reduce your personal risk of cancer and other serious secondary diseases of the metabolic syndrome".

 World Diabetes Day was introduced by the International Diabetes Federation and the WHO and was first celebrated on November 14, 1991. Since 2007, World Diabetes Day has been an official United Nations day of action. The date, November 14, was chosen to commemorate the birthday of Sir Frederick Banting, who discovered insulin in 1922 together with Charles Best.

Supplement by the NCT Heidelberg

A new cohort study on more than 12.6 million individuals, which was conducted at NCT and published in the PLoS Medicine journal***, for the first time provided evidence-based information for risk-adapted starting ages of CRC screening for patients with diabetes, who are at higher risk of early-onset CRC than the general population. "Diabetic patients should start colorectal cancer screening about 5 years earlier than non-diabetics; and patients with both diabetes and family history of CRC could be screened 1-2 decades earlier than the general population," reports Mahdi Fallah, leader of the Risk Adapted Prevention (RAD) Group at DKFZ and NCT. “The guidelines for colorectal cancer screening should take this evidence into account and clinicians could inform patients with diabetes (with or without family history of colorectal cancer) about this possibility and encourage personalized counselling for colorectal cancer screening”, added Elham Kharazmi, co-leader of the study.

 References:
* Toshiaki Ohkuma. Diabetology 2018, DOI: https://doi.org/10.1007/s00125-018-4664-5

** Uzair Ali Khan, Mahdi Fallah, Yu Tian, Kristina Sundquist, Jan Sundquist, Hermann Brenner, and Elham Kharazmi. Personal History of Diabetes as Important as Family History of Colorectal Cancer for Risk of Colorectal Cancer: A Nationwide Cohort Study

Am J Gastroenterol 2020, DOI: https://doi.org/10.14309/ajg.0000000000000669

*** Uzair Ali Khan, Mahdi Fallah, Kristina Sundquist, Jan Sundquist, Hermann Brenner, and Elham Kharazmi. Risk of colorectal cancer in patients with diabetes mellitus: A Swedish nationwide cohort study. PLoS Med 2020 (11): e1003431. https://doi.org/10.1371/journal.pmed.1003431 

Information on a healthy lifestyle is available from the cancer information service at: https://www.krebsinformationsdienst.de/vorbeugung/krebs-vorbeugen/ernaehrung-praevention/index.php

Individual questions to a healthy life-style answer the cancer information service daily from 8:00 clock to 20:00 clock under the free telephone number 0800-420 30 40 or by email under krebsinformationsdienst(at)dkfz.de attainable.

Press contact:
Dr. Sibylle Kohlstädt
German Cancer Research Center (DKFZ)
Strategic Communication and Public Relations Im Neuenheimer Feld 280
69120 Heidelberg
Tel.: +49 6221 42-2843
E-mail: s.kohlstaedt(at)dkfz.de
www.dkfz.de

Dr. Friederike Fellenberg
National Center for Tumor Diseases Heidelberg (NCT) Press and Public Relations Im Neuenheimer Feld 460
69120 Heidelberg
Tel.: +49 6221 42-1755
E-mail: friederike.fellenberg(at)nct-heidelberg.de
www.nct-heidelberg.de

German Cancer Research Center (DKFZ)
The German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ) with its more than 3,000 employees is the largest biomedical research institution in Germany. More than 1,300 scientists at the DKFZ investigate how cancer develops, identify cancer risk factors and search for new strategies to prevent people from developing cancer. They are developing new methods to diagnose tumors more precisely and treat cancer patients more successfully. The DKFZ's Cancer Information Service (KID) provides patients, interested citizens and experts with individual answers to all questions on cancer.
Jointly with partners from the university hospitals, the DKFZ operates the National Center for Tumor Diseases (NCT) in Heidelberg and Dresden, and the Hopp Children's Cancer Center KiTZ in Heidelberg. In the German Consortium for Translational Cancer Research (DKTK), one of the six German Centers for Health Research, the DKFZ maintains translational centers at seven university partner locations. NCT and DKTK sites combine excellent university medicine with the high-profile research of the DKFZ. They contribute to the endeavor of transferring promising approaches from cancer research to the clinic and thus improving the chances of cancer patients.
The DKFZ is 90 percent financed by the Federal Ministry of Education and Research and 10 percent by the state of Baden-Württemberg. The DKFZ is a member of the Helmholtz Association of German Research Centers.

National Center for Tumor Diseases (NCT) Heidelberg
The National Center for Tumor Diseases (NCT) Heidelberg is a joint institution of the German Cancer Research Center, Heidelberg University Hospital (UKHD) and German Cancer Aid. The NCT's goal is to link promising approaches from cancer research with patient care from diagnosis to treatment, aftercare and prevention. This is true for diagnosis and treatment, follow-up care or prevention. The interdisciplinary tumor outpatient clinic is the central element of the NCT. Here, the patients benefit from an individual treatment plan prepared in interdisciplinary expert rounds, so-called tumor boards. Participation in clinical studies provides access to innovative therapies. The NCT thereby acts as a pioneering platform that translates novel research results from the laboratory into clinical practice. The NCT cooperates with self-help groups and supports them in their work. Since 2015, the NCT Heidelberg has maintained a partner site in Dresden. The Hopp Children's Cancer Center (KiTZ) was established in Heidelberg in 2017. The pediatric oncologists at KiTZ work together in parallel structures with the NCT Heidelberg.

Press release of the German Cancer Research Center (DKFZ) with a supplement by the NCT Heidelberg

Preventing diabetes means preventing cancer

On the occasion of World Diabetes Day on November 14, the German Cancer Research Center (DKFZ) will inform about the connections between cancer and diabetes - and why a healthy lifestyle can reduce the risk of both serious diseases at the same time.

 Diabetes type 2 is on the rise worldwide: According to the WHO, in 1980 around 108 million people were affected by the severe metabolic disease, by 2014 the figure had risen to 422 million. The number of diabetics is rising particularly sharply in the emerging markets. In Germany, around 500,000 people are diagnosed with diabetes for the first time every year.

 Numerous epidemiological studies have confirmed over the last few years that diabetics have a significantly increased risk of developing cancer. A meta-analysis by Australian scientists* showed in 2018 that the cancer risk of male diabetics is 19 percent higher than the risk of the general population, and for female diabetics even 27 percent. In a recent publication**, scientists from the DKFZ and the National Center for Tumor Diseases (NCT) Heidelberg prove this correlation for colorectal cancer, especially for diseases in younger age groups. 

 But how can type 2 diabetes influence the development of cancer? Today, experts assume that the risk of cancer is increasing even before type 2 diabetes has even been diagnosed: In many cases, the actual "diabetes" is preceded by a metabolic derailment, which is known as the metabolic syndrome. The syndrome is characterized by four main features: obesity, especially in the abdominal area, as well as misregulated blood lipids, elevated blood pressure and elevated blood sugar, often already associated with insulin resistance.

 "With the metabolic syndrome, we therefore also speak of the deadly quartet," says Mathias Heikenwälder, metabolic expert from the DKFZ, and continues: "Abdominal fat is particularly dangerous in terms of cancer development. This is because this fatty tissue releases messenger substances into the environment that trigger inflammatory reactions and reduce the effect of insulin, so-called adiponectins and cytokines. Some of these messenger substances also act as growth factors. They stimulate other cells to divide and thus also promote tumor growth. In addition, the fat cells produce estrogens, which can stimulate cell growth in hormone-sensitive tissue of the breast and uterus.

 If the metabolic syndrome persists for years, type 2 diabetes can develop. Other frequent secondary diseases are arteriosclerosis, heart attacks, strokes - and cancer.

However, the serious health consequences of the metabolic syndrome can be averted - an adjustment in lifestyle can halt the pathological development. "Nutrition and exercise are the levers that sufferers have to use," says Susanne Weg-Remers, head of the Cancer Information Service at the DKFZ.

First of all, this means eating a conscious and balanced diet, with a balanced energy balance. Regular physical exercise, preferably 30 minutes a day, is just as important. Exercise increases energy consumption and thus helps to lose excess weight. However, Weg-Remers also knows how difficult it is for most people to get rid of years of unhealthy habits. "But it is worth it: If you take timely and consistent countermeasures, you can significantly reduce your personal risk of cancer and other serious secondary diseases of the metabolic syndrome".

 World Diabetes Day was introduced by the International Diabetes Federation and the WHO and was first celebrated on November 14, 1991. Since 2007, World Diabetes Day has been an official United Nations day of action. The date, November 14, was chosen to commemorate the birthday of Sir Frederick Banting, who discovered insulin in 1922 together with Charles Best.

Supplement by the NCT Heidelberg

A new cohort study on more than 12.6 million individuals, which was conducted at NCT and published in the PLoS Medicine journal***, for the first time provided evidence-based information for risk-adapted starting ages of CRC screening for patients with diabetes, who are at higher risk of early-onset CRC than the general population. "Diabetic patients should start colorectal cancer screening about 5 years earlier than non-diabetics; and patients with both diabetes and family history of CRC could be screened 1-2 decades earlier than the general population," reports Mahdi Fallah, leader of the Risk Adapted Prevention (RAD) Group at DKFZ and NCT. “The guidelines for colorectal cancer screening should take this evidence into account and clinicians could inform patients with diabetes (with or without family history of colorectal cancer) about this possibility and encourage personalized counselling for colorectal cancer screening”, added Elham Kharazmi, co-leader of the study.

 References:
* Toshiaki Ohkuma. Diabetology 2018, DOI: https://doi.org/10.1007/s00125-018-4664-5

** Uzair Ali Khan, Mahdi Fallah, Yu Tian, Kristina Sundquist, Jan Sundquist, Hermann Brenner, and Elham Kharazmi. Personal History of Diabetes as Important as Family History of Colorectal Cancer for Risk of Colorectal Cancer: A Nationwide Cohort Study

Am J Gastroenterol 2020, DOI: https://doi.org/10.14309/ajg.0000000000000669

*** Uzair Ali Khan, Mahdi Fallah, Kristina Sundquist, Jan Sundquist, Hermann Brenner, and Elham Kharazmi. Risk of colorectal cancer in patients with diabetes mellitus: A Swedish nationwide cohort study. PLoS Med 2020 (11): e1003431. https://doi.org/10.1371/journal.pmed.1003431 

Information on a healthy lifestyle is available from the cancer information service at: https://www.krebsinformationsdienst.de/vorbeugung/krebs-vorbeugen/ernaehrung-praevention/index.php

Individual questions to a healthy life-style answer the cancer information service daily from 8:00 clock to 20:00 clock under the free telephone number 0800-420 30 40 or by email under krebsinformationsdienst(at)dkfz.de attainable.

Press contact:
Dr. Sibylle Kohlstädt
German Cancer Research Center (DKFZ)
Strategic Communication and Public Relations Im Neuenheimer Feld 280
69120 Heidelberg
Tel.: +49 6221 42-2843
E-mail: s.kohlstaedt(at)dkfz.de
www.dkfz.de

Dr. Friederike Fellenberg
National Center for Tumor Diseases Heidelberg (NCT) Press and Public Relations Im Neuenheimer Feld 460
69120 Heidelberg
Tel.: +49 6221 42-1755
E-mail: friederike.fellenberg(at)nct-heidelberg.de
www.nct-heidelberg.de

German Cancer Research Center (DKFZ)
The German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ) with its more than 3,000 employees is the largest biomedical research institution in Germany. More than 1,300 scientists at the DKFZ investigate how cancer develops, identify cancer risk factors and search for new strategies to prevent people from developing cancer. They are developing new methods to diagnose tumors more precisely and treat cancer patients more successfully. The DKFZ's Cancer Information Service (KID) provides patients, interested citizens and experts with individual answers to all questions on cancer.
Jointly with partners from the university hospitals, the DKFZ operates the National Center for Tumor Diseases (NCT) in Heidelberg and Dresden, and the Hopp Children's Cancer Center KiTZ in Heidelberg. In the German Consortium for Translational Cancer Research (DKTK), one of the six German Centers for Health Research, the DKFZ maintains translational centers at seven university partner locations. NCT and DKTK sites combine excellent university medicine with the high-profile research of the DKFZ. They contribute to the endeavor of transferring promising approaches from cancer research to the clinic and thus improving the chances of cancer patients.
The DKFZ is 90 percent financed by the Federal Ministry of Education and Research and 10 percent by the state of Baden-Württemberg. The DKFZ is a member of the Helmholtz Association of German Research Centers.

National Center for Tumor Diseases (NCT) Heidelberg
The National Center for Tumor Diseases (NCT) Heidelberg is a joint institution of the German Cancer Research Center, Heidelberg University Hospital (UKHD) and German Cancer Aid. The NCT's goal is to link promising approaches from cancer research with patient care from diagnosis to treatment, aftercare and prevention. This is true for diagnosis and treatment, follow-up care or prevention. The interdisciplinary tumor outpatient clinic is the central element of the NCT. Here, the patients benefit from an individual treatment plan prepared in interdisciplinary expert rounds, so-called tumor boards. Participation in clinical studies provides access to innovative therapies. The NCT thereby acts as a pioneering platform that translates novel research results from the laboratory into clinical practice. The NCT cooperates with self-help groups and supports them in their work. Since 2015, the NCT Heidelberg has maintained a partner site in Dresden. The Hopp Children's Cancer Center (KiTZ) was established in Heidelberg in 2017. The pediatric oncologists at KiTZ work together in parallel structures with the NCT Heidelberg.