Incidence of HPV-related Anogenital Intraepithelial Neoplasia and Cancer in Men With Diabetes Compared With the General Population : Epidemiology

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Infectious Diseases

Incidence of HPV-related Anogenital Intraepithelial Neoplasia and Cancer in Men With Diabetes Compared With the General Population

Reinholdt, Kristiana; Thomsen, Louise Thirstrupa; Munk, Christiana; Dehlendorff, Christianb; Carstensen, Bendixc; Jørgensen, Marit Eikac,d; Kjaer, Susanne Krügera,e

Author Information

From the aUnit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark

bStatistics and Data Analysis, Danish Cancer Society Research Center, Copenhagen, Denmark

cSteno Diabetes Center Copenhagen, Copenhagen, Denmark

dUniversity of Southern Denmark, Odense, Denmark

eDepartment of Gynecology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.

Submitted October 21, 2020; accepted May 12, 2021

S.K.K. has received lectures fees from Merck and a research grant through her institution from Merck. M.E.J. has received research grants from Astra Zeneca, Sanofi Aventis, AMGEN, Boehringer Ingelheim and holds shares in Novo Nordisk A/S. B.C. holds shares in Novo Nordisk A/S and has received lecture and consultancy fees from Novo Nordisk and Leo Pharma. All other authors declare no potential conflicts of interest.

Individual participant data for this study are not available for data sharing. The study protocol, including data management plan and statistical analysis plan, is available on request.

Supplemental digital content is available through direct URL citations in the HTML and PDF versions of this article (www.epidem.com).

Correspondence: Susanne Krüger Kjær, Unit of Virus, Lifestyle, and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Denmark. E-mail: [email protected].

Epidemiology 32(5):p 705-711, September 2021. | DOI: 10.1097/EDE.0000000000001375

Abstract

Background: 

Diabetes may increase risk of human papillomavirus (HPV)–related precancer and cancer. We estimated incidence of penile and anal high-grade intraepithelial neoplasia (hgPeIN, hgAIN) and squamous cell carcinoma (SCC) in men with diabetes compared with the entire Danish male population without diabetes.

Methods: 

In this registry-based cohort study, we included all men born 1916–2001 and residing in Denmark (n = 2,528,756). From nationwide registries, we retrieved individual-level information on diabetes, educational level, and diagnoses of hgPeIN, hgAIN, penile SCC, and anal SCC. We used Poisson regression models to estimate incidence of hgPeIN, hgAIN, penile SCC, and anal SCC as a function of diabetes status, attained age, calendar period, and education. We estimated incidence rate ratios (IRRs) of each outcome in men with diabetes compared with nondiabetic men, both for diabetes overall and separately for type 1 (T1D) and type 2 diabetes (T2D).

Results: 

Men with diabetes had increased incidence rate of penile SCC compared with nondiabetic men (IRR = 1.5, 95% CI = 1.2, 1.9). We saw similar trends for anal SCC, hgPeIN, and hgAIN. The combined incidence rate of penile and anal SCC was increased in men with T2D (IRR = 1.5, 95% CI = 1.3, 1.8), but not with T1D (IRR = 0.53, 95% CI = 0.20, 1.4) compared with men without diabetes.

Conclusion: 

The incidence of penile and anal high-grade intraepithelial neoplasia and SCC in men with diabetes was increased compared with men without diabetes. For penile and anal SCCs, this was primarily due to an increased risk in men with T2D.

Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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