Association between diabetes mellitus and adverse characteristics of breast cancer at presentation
Introduction
Type 2 diabetes mellitus is a major health problem, affecting more than 6.5% of the adults and up to 15% of the elderly population in the United States.1 Type 2 diabetes mellitus, which accounts for 95% of diabetes cases, is a high insulin state, caused by insulin resistance in fat and muscle tissues, which leads to increased production of insulin. β Cells could decompensate and low insulin levels may occur, but only in the late stages of the disease. The main risk factors for type 2 diabetes mellitus are genetic predisposition, older age and obesity.2 Diabetes mellitus is associated with increased risk, as well as worse outcome, of various malignancies, including endometrial, colon and pancreatic cancers.3, 4, 5, 6
Breast cancer is another common disease, affecting one of every eight women during her lifetime.7 Up to 16% of older breast cancer patients also suffer from diabetes.8 An association between type 2 diabetes mellitus and an increased risk of breast cancer has been suggested by some, but not all, studies.9, 10, 11 We recently conducted a meta-analysis of published studies and found the association to be significant although modest.12 Three mechanisms may operate in both diabetes mellitus and breast cancer: altered endogenous sex-hormone regulation, activation of the insulin-like growth factor (IGF) signalling pathway and activation of the insulin-signalling pathway.2, 12, 13 Obesity, the major risk factor for type 2 diabetes, is also associated with significantly increased risk of breast cancer incidence, presumably due to activation of these three mechanisms.14 In addition to the biological mechanisms connecting diabetes to breast cancer, diabetes has also been associated with inadequate use of screening mammography and administration of therapy not consistent with consensus guidelines.15, 16, 17
The association between diabetes mellitus and the clinical and pathological characteristics of breast cancer are currently unexplored. In this study, we have investigated the association between type 2 diabetes mellitus on the clinical and pathological characteristics of consecutive diabetic breast cancer patients who were treated at the oncology institute of Sheba Medical Center, Tel Aviv, Israel between 1999 and 2002.
Section snippets
Study population
The study population included all consecutive type 2 diabetic female patients, newly diagnosed for invasive breast cancer, that were treated at the oncology institute of Sheba Medical Center, Tel Aviv, Israel between 01/1999 and 10/2002. If patients were not treated by insulin or oral hypoglycemic therapy, the diagnosis of type 2 diabetes mellitus was confirmed, according to the definitions of the American Diabetic Association, by the presence of fasting glucose levels of above 126 mg/dl in
Patients’ characteristics
Of 1448 newly diagnosed breast cancer patients admitted during the study period, 79 diabetic breast cancer patients who met the study criteria were identified and matched to 158 non-diabetic breast cancer patients. The majority of the diabetic patients were treated by oral hypoglycemic agents (n = 49, 62%), and the rest by either diet (n = 20, 25%) or insulin (n = 10, 13%).
Patients’ characteristics are presented in Table 1. The mean age at diagnosis was 64.9 ± 10 years for both groups, (range 31–90
Discussion
In this study, we investigated the association between type 2 diabetes mellitus and breast cancer characteristics at diagnosis, as well as differences in therapeutic modalities provided for these patients. The comparison of consecutive 79 diabetic with 158 matched non-diabetic breast cancer patients showed that the diabetic group presented with a larger tumour size at diagnosis and thus with a more advanced stage. These results remained significant after adjustment for BMI was performed.
Conflict of interest statement
The authors have no conflict of interest to disclose.
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