IGF1 and hyperinsulinism: As we suggested earlier for colorectal cancer when we observed a higher risk with short duration of T2DM [12], the interpretation of results on the associations between the onset of T2DM and duration of exposure to T2DM on one hand and cancer risk on the other, is complex when considering a dynamic underlying pathway that involves varying degrees of insulin resistance and hyperinsulinemia, and associated alterations in IGF levels.