Endocrine Abstracts

Cervical cancer is the fourth most common cancer among women globally and second most common in India. As per WHO, almost 90% of new cases and deaths worldwide, occurred in low to middle income countries in 2020. More than 95% of cervical cancers are associated with chronic Human papilloma virus infection (HPV), particularly of the types 16 and 18. High income countries have vaccination and screening programs that are in place for young girls but low-and middle-income countries usually do not have access to such facilities. Another disease that is increasing in incidence and prevalence in such populations is diabetes mellitus. Diabetes is known to be associated with increased incidence of various cancers like endometrial, cervical, breast, stomach and pancreas. It is also observed that cancer patients with diabetes have an overall reduced survival as compared to non-diabetics. We undertook this study to observe frequency and pattern of cervical pathologies (using routine pap smear) among diabetic females from reproductive age group and compared them with non-diabetic females. The idea was to observe if diabetic females have higher prevalence of cervical pathologies which might progress to cervical cancer in future. We found that diabetes was associated with higher occurrence of cervical pathologies like cervicitis (Odd’s Ratio 10.9), vaginitis (OR 1.23), HPV infection (OR 1.4) and malignant changes (OR 1.52). We then attempted to find genetic association between diabetes and cervical pathologies to determine if there are overlapping predisposing genes that can explain higher preponderance of diabetics towards cervical pathologies. This was done by applying gaussian mixture modelling on available genetic data for diabetes mellitus (types 1 and 2), chronic HPV infection, cervical intra-epithelial neoplasia (CIN) and cervical cancer. Some MHC loci like HLA-DQA1, HLA DQB1 were found to be overlapping, which was expected. Apart from MHC genes, certain genes showed positive association with both spectrums (diabetes and cervical pathologies) like INS-IGF2, TTC7B, SILC1. The genetic association may help in understanding the connection between the two diseases in a better way and may also help in predicting higher chances of cervical pathologies in populations with higher preponderance towards upregulation of such genes.