Bladder Cancer Screening Among Diabetic Patients On Metformin Therapy In A West Africa Subregion

Ufuoma Miller Fakpor, Ekpe Ekpe Lawson, Omotoso Ayodele Joshua


Objective: The use of certain medications among diabetic patients put them at risk of developing bladder cancer. This study was done to examine the effects of metformin therapy on the bladder of diabetic patients and to assess the correlation between the effects of metformin and its duration of therapy. Methods: A total of 150 diabetic patients were sampled using a cross sectional study design. 10-15mls of random urine samples were collected into sterile containers over a period of five weeks. Smears were prepared, fixed and stained using Papanicolaou staining method and examined under the microscope for cytological studies. Results: The probability of developing bladder cancer among diabetic patients on metformin therapy is 0% among participants of all categories: 99 females and 51 males partook in this study.  Peak age group (35.33%) were between the ages of 51 to 60 years, least age group (4.67%) were 80 years and above. Traders of food items and used clothes constituted the peak occupational group of 27.52%, with fishermen  as least occupation group(0.67%), age group 61 to 70 had the highest duration of therapy of (15.8%), the least duration of (4.625%) was among age group 25 to 30 years, the group of 80years and above had a duration of (4.857%).  No inflammatory, degenerative, benign or malignant cells were observed among urine samples from diabetic patients on metformin. Conclusion: This study equips us with knowledge that metformin therapy has no direct influence on the development of cancer of the bladder among diabetic patients as observed through urine cytology. This is the first time such study is done in West Africa region. The clinical implication is that Metformin, the commonest prescribed oral hypoglycemic is safe when considering the carcinogenic effects of anti-diabetic drugs, unlike insulin and some other drugs which have carcinogenic potential.


Keywords: metformin; cancer; bladder; diabetes; therapy

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Edward G, Daniel H, Michael A, Richard MB, Susan G, Laurela H, Michael P, Judith G, Douglas M. Diabetes and cancer. Diabetes Care. 2009;33: 1674 – 85.

Chowdhury TA. Diabetes and Cancer. QJM. Journal of the Association of Physician 2011;103: 905-915. cancer)

Marriane BY, Susan AO, Ulka BC, Carol BK. Incidence of cancer with type 2 diabetes. Diabetes and metabolic syndrome.2009; 3612-16:

Siegel R, Nashadham D, Jemal A. cancer statistics. Cancer J Clin 2012;62:10-29.

Pira E, Pislatto G, Negri E, Romano C, Boffetta et al. Bladder cancer mortality and workers exposed to aromatic amines: A 58 year old follow up. J National Cancer Inst. 2010;102: 1096-1099.

Bulbuyan MA, Figgs LW, Zahn SH, Savitskaya T, Goldford A. Cancer incidence and mortality among beta-naphtalamine and benzidine dye workers in Moscow. Int. J. Epidemol 1995;24: 266-275.

Behrens L, Schill W, Ahrens W. Elevated cancer mortality in a German cohort of bitumen workers. J. Occup Environ Hyg. 2004;6: 555-561.

Fermici LM, Sinha R, Ward MH, Graubard BL, Hollenbeck AR. Meat and components of meat and the risk of bladder cancer in the NIH-AARP. Diet and health study. CANCER 116:4345-4353.

Guha N, Steenland NK, Merleth F, Altier A, Cagliano V. et al. Bladder cancer in painters: A meta analysis. Occup Environ Med. 67: 568-573.

Fernandez MJ, Lopez JF, Vilvadi B, Coz F, long term prosper of arsenic in drinking water in bladder cancer health care and mortality water 20 years after end of exposure. J UROL 2012; 187: 856-861.

Freedman ND, Siverman DT, Hollenbeck AR, Schatzkin A, Abret CC. Association between smoking and risk of bladder cancer among men and women. JAMA 2011; 306: 737-745.

Ben Q, Xu M, Ning X, Liu J, Hong S. et al. Diabetes mellitus and the risk of pancreatic cancer. Eur J Cancer 2011; 47: 1928-1937.

Wang C, Wang X, Gong G, Qui W. et al. Increase risk of hepatocellular carcinoma in patients with diabetes mellitus. Int J Cancer. 130: 1639-1648.

Yuhara H, Steinman C, Cohen SE, Corley DA, Tei Y. et al. Is diabetes an independent risk factor for colon cancer and rectal cancer. Am J Gastroenterol 2011;106: 1911-1921.

Kasper JS, Giovannuci E. A meta analysis of diabetes mellitus and risk of prostate cancer. Cancer Epidermiol Biomarker Prev. 2006;15:2056-2062.

Cheng KC, Chen YL, Pang YT, Sung FC. Risk of oesophagus cancer in diabetes mellitus-A population based study in Taiwan. BMC Gastro enterol 2012,12: 777.

Ekpe EL, Omotoso AJ. Diabetes mellitus and the risk of cancer formation: Possible link and review of literature. American journal of Internal Medicine 2015;3(4):180-184

Giovannucci E, Hallan DM, Archer MC, Bergenstal RM, Gapstor SM, Habel LA, et al. Diabetes and cancer: A consensus report. Diabetes Cares 2010;33(7): 1674-85:

Tseng CH, Tseng FH. Diabetes and gastric cancer -the potential link. World J Gastroenterol 2014; 20(7):1701-1711.

Ahmad Shazaib, Chowdhury TA, Boucher BJ.Diabetes and cancer:Could Vitamin D provide the link? Journal of Diabetes and its complications.2012;10(5).

Kourelis TV, Siegal RD, metformin and cancer: new application for an old drug. Med. Oncol. 29(2). 1314-27.

Ferlay J, Randi G, Bossett C, Loui F, Negri E et al. Declining mortality from bladder cancer in Europe. BJU Int 2008;10(1): 11-9:

Colombel M, Soloway M, Akasa H, Bohle A. et al epidemiology, staging grading and risk stratification of bladder cancer. European Urology. 7(10): 618-626.

Murta-Nascimento , BJ Schmitz-Drager ,MP Zeeger et al. Epidemiology of urinary bladder cancer from tumor development to patient health. World J Urol. 2007;25:285-295.

PJ McCarthy, CA Harris, E Neal. The accuracy of recording of occupational history in patients with bladder cancer. Br J Urol 1997;19: 91-93. 1997.

MP Zeegers, FE Tan, Dovant PA, van den Brendt. The impact of characteristic of cigarette smoking on urinary tract cancer risk. CANCER 2000;89: 630-639.

P Veneis, L Simonato, Proportion of lung and bladder cancer of male resulting from occupation: A systematic approach. Arch Environ Health. 1991;46: 6-15.

Chung KT. The etiology of bladder cancer and its prevention.J Cancer Sci Ther 2013;5(10):346-361.

Chung KT. The etiology of bladder cancer and its prevention.J Cancer Sci Ther 2013:5(10):346-361.

Boffetta P,Jourenkora N,ustavasson. Cancer risk from occupational and experimental exposure to polycyclic aromatic hydrocarbons. Cancer causes and control 8:444-472.1992

Golka K, Wiese A, Assenato G, Bolt M. Occupational exposure and urologic cancer. World J Urol 2004;21:382-391.

Travis LB,Curtis RE, Glimelius et al.Bladder and kidney cancer following cyclophosphamide therapy from non-Hodgkins lymphoma.J Natl Cancer Inst 1995;87:524-30.

Kanto AF, Hartge P, Hoover RN, et al. Urinary tract infection and risk of bladder cancer. Am J Epidermol 1984;119:510-515.

Evans JM, Donnelly LA, Emshie-Smith AM, Alessi DR, Andrew Morris. Metformin and reduced risk of cancer in diabetic patients.BMJ 2005;330(503):1304.

Libby G, Louis Donnelly,Peter Donan, Dario Andrew Morris, Josie MM. New uses of metformin are at low risk of incident cancers. Diabetes Care 2009;32:1620-1625.

Hirsch HA,Dimitrious I,Tsichlis PN,Struhl K. Metformin selectively targets cancer stem cells and acts together with chemotherapy to block tumor growth and prolong remission. Cancer Res 2009;69(190):7507-7511.

Bowker SL, Marjumdar SR, Veugester P, Johnson J. Increased cancer – related mortality for patients with type 2 diabetes who use sulphonureas or insulin – Diabetes Care 2006;29(2): 254-258.

Shackelford DB, Shaw RJ. The LKB1-AMPK pathway: metabolism and growth control in tumor suppression. Nat Revl Cancer. 2009;9(8): 567-573.

Zakikhani M, Dowling R, Fantus TG, Sonenberg N, Pollak M. Metform is an AMP kinase – dependent growth inhibitor for breast cancer cells Cancer Res. 2006;16(2): 10269-73.

Zakikhani M, Dowling R, Fantus TG, Sonenberg N, Pollak M. The effect of adiponectin and metformin on prostate and colon neoplasia involve activation on AMP-activated kinase. Cancer Prev. Res.2008; 1(5): 369-75.

Quieroz EA, Puukila S, Eichler R, Sampaio SC et al. metformin induces apoptosis and cell cycle arrest mediated by oxidative stress, AMP and FOXO 3a in MCF. 7 breast cancer cell. Plos One. 2014;9(5): E 982.

Dowling Ryan JO, Goodwin PJ, Stambolic V. Understanding the benefit of metformin use in cancer treatment. BMC Med. 2011;9(33):

Scarpello JHB, Howlett HCS. Metforum therapy and its clinical uses. Diabetes and vascular disease research. 2008;5(3)

Bradford SA, Khan A. individualizing chemotherapy using the anti-diabetic drug metformin as an adjuvant: an exploratory study. Cancer Sci. Ther 2013;5(3)

Hosono K, Endo H, Takahashi H, Sugiyama M, Sakai E, Uchiyama T, Suzuki K.Metformin suppresses altered aberrant cancer crpts foci in a short term clinical trial.Cancer Rev Res 2010;36:1077-1083.

Dowling JO, Goodwin PJ, Stambolic. Understanding the benefit of metformin use in cancer treatment .BMC Medicine 2011;9:33

Zhang Tao,Zhan Yinan, Guo Peng, Xiong Hui et al.The anti-diabetic drug metformin inhibits the proliferation of bladder cancer cells in vitro and in vivo. Int J Mol Sci 2013;14(12):24603-24618.

Bennett AM, Tonks N. Regulation of distinct stages of skeletal muscle differentiation by mitogen-activated protein kinase.Science 1997;278(5341):1288-1291.

Lui Tsan Zon, Chen Chung Y, Yiin Shuen et al. Molecular mechanism of cell cycle blockage of hepatoma cells through suppression of mitogen-activated protein kinase. Food and Chemical Toxicology 2006;446:227-235.

Rieken M, Xylinase E, Kluth L, Crivelli JJ et al. Effect of diabetes mellitus and metformin use of oncologic outcome of patients treated with radical cystectomy.Urol Oncol 2013;32(1):7-49.

Pulito C, Rana TP, Sanli T, Muti P, Blandino G. Metformin: On going journey across diabetes,cancer therapy and prevention.Metabolites 2013;3(4):1051-1075.

Witters LA.The blooming of French lilac. J Clin Invest.2001;108:1105-1107.

Rizos C , Elisaf MS. Metformin and cancer. Eur J Pharmacol 2013;705(1-3):96-105.

Patel T, Hruby G, Badani K, Abale Shen C, Mckierman JM. Clinical outcomes after radical prostatectomy in diabetics patients treated with metformin. Urology 2010;76:1240-1244.


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