Skip to main content

Advertisement

SpringerLink
Log in

The association between diabetes and breast cancer stage at diagnosis: a population-based study

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Women with diabetes have higher breast cancer incidence and mortality. The purpose of this study was to examine the impact of diabetes on stage at breast cancer diagnosis, as a possible reason for their higher mortality. Using population-based health databases from Ontario, Canada, this retrospective cohort study examined stage at diagnosis (II, III, or IV vs I) among women aged 20–105 years who were newly diagnosed with invasive breast cancer between 2007 and 2012. We compared those with diabetes to those without diabetes. Diabetes was defined based on medical records using a validated algorithm. Among 38,407 women with breast cancer, 6115 (15.9 %) women had diabetes. Breast cancer patients with diabetes were significantly more likely to present with advanced-stage breast cancer than those without diabetes. After adjustment for mammograms and other covariates, diabetes was associated with a significantly increased risk of Stage II [adjusted odds ratio (aOR) 1.14, 95 % confidence interval (CI) 1.07, 1.22], Stage III (aOR 1.21, 95 % CI 1.11, 1.33), and Stage IV (aOR 1.16, 95 % CI 1.01, 1.33) versus Stage I breast cancer. Women with diabetes had a higher risk of lymph node metastases (aOR 1.16, 95 % CI 1.06, 1.27) and tumors with size over 2 cm (aOR 1.16, 95 % CI 1.06, 1.28). Diabetes was associated with more advanced-stage breast cancer, even after accounting for differences in screening mammogram use and other factors. Our findings suggest that diabetes may predispose to more aggressive breast cancer, which may be a contributor to their higher cancer mortality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Noto H et al (2011) Significantly increased risk of cancer in patients with diabetes mellitus: a systematic review and meta-analysis. Endocr. Pract. 17(4):616–628

    Article  PubMed  Google Scholar 

  2. Barone BB et al (2008) Long-term all-cause mortality in cancer patients with preexisting diabetes mellitus: a systematic review and meta-analysis. JAMA 300(23):2754–2764

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  3. Peairs KS et al (2011) Diabetes mellitus and breast cancer outcomes: a systematic review and meta-analysis. J. Clin. Oncol. 29(1):40–46

    Article  PubMed Central  PubMed  Google Scholar 

  4. Lipscombe LL et al (2008) The impact of diabetes on survival following breast cancer. Breast Cancer Res. Treat. 109(2):389–395

    Article  PubMed  Google Scholar 

  5. Emerging Risk Factors C. et al, (2011) Diabetes mellitus, fasting glucose, and risk of cause-specific death. N. Engl. J. Med. 364(9):829–841

    Article  Google Scholar 

  6. van de Poll-Franse LV et al (2006) Increased health care utilisation among 10-year breast cancer survivors. Support Care Cancer 14(5):436–443

    Article  PubMed  Google Scholar 

  7. Lee L et al (2011) Impact of comorbidity on chemotherapy use and outcomes in solid tumors: a systematic review. J. Clin. Oncol. 29(1):106–117

    Article  PubMed  Google Scholar 

  8. Gross CP et al (2007) The impact of chronic illnesses on the use and effectiveness of adjuvant chemotherapy for colon cancer. Cancer 109(12):2410–2419

    Article  PubMed  Google Scholar 

  9. Howlader N et al ((1975–2008)) SEER cancer statistics review. National Cancer Institute. Bethesda, MD. 2011 2011/08/20/. http://seer.cancer.gov/csr/1975_2008/

  10. Chan W et al (2014) Impact of socioeconomic status on breast cancer screening in women with diabetes: a population-based study. Diabet. Med. 31(7):806–812

    Article  CAS  PubMed  Google Scholar 

  11. Lipscombe LL, Hux JE, Booth GL (2005) Reduced screening mammography among women with diabetes. Arch. Intern. Med. 165(18):2090–2095

    Article  PubMed  Google Scholar 

  12. McBean AM, Yu X (2007) The underuse of screening services among elderly women with diabetes. Diabetes Care 30(6):1466–1472

    Article  PubMed  Google Scholar 

  13. Beckman TJ et al (2001) Screening mammogram utilization in women with diabetes. Diabetes Care 24(12):2049–2053

    Article  CAS  PubMed  Google Scholar 

  14. Jimenez-Garcia R et al (2009) Prevalence and predictors of breast and cervical cancer screening among Spanish women with diabetes. Diabetes Care 32(8):1470–1472

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  15. Marshall JG et al (2010) Regional variations in cancer screening rates found in women with diabetes. Nurs. Res. 59(1):34–41

    Article  PubMed  Google Scholar 

  16. Zhao G et al (2009) Prevalence and trends of receipt of cancer screenings among US women with diagnosed diabetes. J. Gen. Intern. Med. 24(2):270–275

    Article  PubMed Central  PubMed  Google Scholar 

  17. Hernandez AV et al (2014) Association between insulin resistance and breast carcinoma: a systematic review and meta-analysis. PLoS One 9(6):e99317

    Article  PubMed Central  PubMed  Google Scholar 

  18. Godsland IF (2010) Insulin resistance and hyperinsulinaemia in the development and progression of cancer. Clin. Sci. 118(5):315–332

    Article  CAS  Google Scholar 

  19. Lawlor DA, Smith GD, Ebrahim S (2004) Hyperinsulinaemia and increased risk of breast cancer: findings from the British Women’s Heart and Health Study. Cancer Causes Control 15(3):267–275

    Article  PubMed  Google Scholar 

  20. Belfiore A et al (2009) Insulin receptor isoforms and insulin receptor/insulin-like growth factor receptor hybrids in physiology and disease. Endocr. Rev. 30(6):586–623

    Article  CAS  PubMed  Google Scholar 

  21. Milazzo G et al (1992) Insulin receptor expression and function in human breast cancer cell lines. Cancer Res. 52(14):3924–3930

    CAS  PubMed  Google Scholar 

  22. De Meyts P et al (1995) Role of the time factor in signaling specificity: application to mitogenic and metabolic signaling by the insulin and insulin-like growth factor-I receptor tyrosine kinases. Metabolism 44(10 Suppl 4):2–11

    Article  PubMed  Google Scholar 

  23. Fleming ST et al (2005) Comorbidity as a predictor of stage of illness for patients with breast cancer. Med. Care 43(2):132–140

    Article  PubMed  Google Scholar 

  24. Srokowski TP et al (2009) Impact of diabetes mellitus on complications and outcomes of adjuvant chemotherapy in older patients with breast cancer. J. Clin. Oncol. 27(13):2170–2176

    Article  PubMed Central  PubMed  Google Scholar 

  25. van de Poll-Franse LV et al (2007) Less aggressive treatment and worse overall survival in cancer patients with diabetes: a large population based analysis. Int. J. Cancer 120(9):1986–1992

    Article  PubMed  Google Scholar 

  26. Hou G et al (2013) Clinical pathological characteristics and prognostic analysis of 1,013 breast cancer patients with diabetes. Breast Cancer Res. Treat. 137(3):807–816

    Article  CAS  PubMed  Google Scholar 

  27. Yancik R et al (2001) Effect of age and comorbidity in postmenopausal breast cancer patients aged 55 years and older. JAMA 285(7):885–892

    Article  CAS  PubMed  Google Scholar 

  28. Taplin SH et al (2004) Reason for late-stage breast cancer: absence of screening or detection, or breakdown in follow-up? J. Natl. Cancer Inst. 96(20):1518–1527

    Article  PubMed  Google Scholar 

  29. van Rossum LG et al (2009) Earlier stages of colorectal cancer detected with immunochemical faecal occult blood tests. Neth. J. Med. 67(5):182–186

    PubMed  Google Scholar 

  30. Robles SC et al (1988) An application of capture-recapture methods to the estimation of completeness of cancer registration. J. Clin. Epidemiol. 41(5):495–501

    Article  CAS  PubMed  Google Scholar 

  31. Cancer Care Ontario (2009) Appendix C2 - Stage: Frequently Asked Questions. https://www.cancercare.on.ca/ext/databook/db1011/Appendix/Appendix_C2_-_CCO_Staging_FAQs_2008-09_FINAL_4_%28Dec-08%29.htm. Accessed 9 Dec 2013

  32. Hux JE et al (2002) Diabetes in Ontario: determination of prevalence and incidence using a validated administrative data algorithm. Diabetes Care 25(3):512–516

    Article  PubMed  Google Scholar 

  33. Canadian Task Force on Preventive Health Care: Screening for breast cancer: recommendations for clinicians and policy-makers. Health, Canada (2011)

  34. Austin PD, Henderson SE (2011) Biopsychosocial assessment criteria for functional chronic visceral pain: a pilot review of concept and practice. Pain Med. 12(4):552–564

    Article  PubMed  Google Scholar 

  35. Lipscombe LL, Hux JE (2007) Trends in diabetes prevalence, incidence, and mortality in Ontario, Canada 1995–2005: a population-based study. Lancet 369(9563):750–756

    Article  PubMed  Google Scholar 

  36. S.I. Inc., (2011) Base SAS® 9.3 Procedures Guide. SAS Institute Inc.: Cary

    Google Scholar 

  37. Smith U, Gale EA (2010) Cancer and diabetes: are we ready for prime time? Diabetologia 53(8):1541–1544

    Article  CAS  PubMed  Google Scholar 

  38. Stein KB et al (2010) Colorectal cancer outcomes, recurrence, and complications in persons with and without diabetes mellitus: a systematic review and meta-analysis. Dig. Dis. Sci. 55(7):1839–1851

    Article  PubMed Central  PubMed  Google Scholar 

  39. Renehan AG et al (2012) Diabetes and cancer (2): evaluating the impact of diabetes on mortality in patients with cancer. Diabetologia 55(6):1619–1632

    Article  CAS  PubMed  Google Scholar 

  40. Kerlikowske K et al (2008) Obesity, mammography use and accuracy, and advanced breast cancer risk. J. Natl. Cancer Inst. 100(23):1724–1733

    Article  PubMed Central  PubMed  Google Scholar 

  41. Geiss LS et al (2014) Prevalence and incidence trends for diagnosed diabetes among adults aged 20 to 79 years, United States, 1980–2012. JAMA 312(12):1218–1226

    Article  CAS  PubMed  Google Scholar 

  42. Iqbal J et al (2015) Differences in breast cancer stage at diagnosis and cancer-specific survival by race and ethnicity in the United States. JAMA 313(2):165–173

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

Dr. Lipscombe is supported by a Canadian Institutes of Health Research (CIHR) New Investigator Award. Dr. Peter Austin is supported in part by a Career Investigator award from the Heart and Stroke Foundation. This study was conducted with the support from a CIHR operating Grant (MOP#123263), and from the Ontario Institute for Cancer Research and Cancer Care Ontario. This study was supported by the Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual Grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript were the responsibilities of the authors. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. Parts of this material are based on data and information provided by Cancer Care Ontario. However, the analysis, conclusions, opinions and statements expressed herein are those of the authors and not necessarily those of Cancer Care Ontario. Dr. Lipscombe had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The authors would like to thank Lauren McNicol, MA, Women’s College Research Institute, for help with manuscript preparation.

Disclosures

None.

Author information

Authors and Affiliations

  1. Women’s College Research Institute, Women’s College Hospital, 790 Bay St, Room 741, Toronto, ON, M5G 1N8, Canada

    Lorraine L. Lipscombe, Ophira Ginsburg, Paula A. Rochon & Steven Narod

  2. Department of Medicine, University of Toronto, Toronto, Canada

    Lorraine L. Lipscombe, Ophira Ginsburg, Paula A. Rochon & Steven Narod

  3. Institute for Clinical Evaluative Sciences, Toronto, Canada

    Lorraine L. Lipscombe, Hadas D. Fischer, Peter C. Austin, Longdi Fu, R. Liisa Jaakkimainen, Paula A. Rochon & Lawrence Paszat

  4. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada

    Lorraine L. Lipscombe, Peter C. Austin, Ophira Ginsburg, Paula A. Rochon & Lawrence Paszat

  5. Department of Family and Community Medicine, University of Toronto, Toronto, Canada

    R. Liisa Jaakkimainen

  6. Sunnybrook Health Sciences Centre, Toronto, Canada

    R. Liisa Jaakkimainen & Lawrence Paszat

Authors
  1. Lorraine L. Lipscombe
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hadas D. Fischer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Peter C. Austin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Longdi Fu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. R. Liisa Jaakkimainen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ophira Ginsburg
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Paula A. Rochon
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Steven Narod
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Lawrence Paszat
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lorraine L. Lipscombe.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lipscombe, L.L., Fischer, H.D., Austin, P.C. et al. The association between diabetes and breast cancer stage at diagnosis: a population-based study. Breast Cancer Res Treat 150, 613–620 (2015). https://doi.org/10.1007/s10549-015-3323-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-015-3323-5

Keywords

Search

Navigation