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The impact of diabetes on survival following breast cancer

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

Abstract

Purpose It has been suggested that type 2 diabetes may affect breast cancer prognosis, possibly due to increased diabetes-related comorbidity, or direct effects of insulin resistance and/or hyperinsulinemia. The purpose of this study was to examine the impact of diabetes on survival following breast cancer. Methods Using population-based health databases from Ontario, Canada, this retrospective cohort study compared deaths between women with breast cancer aged 55–79 years with diabetes and without diabetes. Women were followed for all cause mortality from breast cancer diagnosis until March 31st 2006. Results Of the 6,107 women with breast cancer, 1,011 had diabetes and 5,096 did not have diabetes. Women with diabetes were slightly older, were more likely to reside in a lower income neighborhood, and had greater comorbidity compared to women without diabetes. After a mean follow-up of 5.0 years and adjustment for age, prior mammograms and other covariates, mortality following breast cancer was significantly higher among women with versus without diabetes (hazard ratio, HR 1.39, 95% confidence interval, CI 1.22–1.59, P < 0.0001). The effect of diabetes on mortality was comparable to that seen in women with diabetes without breast cancer over a 7-year follow-up. Conclusion This study found that diabetes was associated with a close to 40% increase in mortality within the first 5 years following breast cancer, which was similar to that seen in women with diabetes without breast cancer. These findings suggest that early survival following breast cancer is reduced in women with diabetes, possibly due to diabetes-related causes.

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Acknowledgements

The Institute for Clinical Evaluative Sciences is funded by the Ontario Ministry of Health and Long-term Care. The opinions, results and conclusions are those of the authors and no endorsement by the Ministry of Health and Long-Term Care or by the Institute for Clinical Evaluative Sciences is intended or should be inferred. The authors gratefully acknowledge the assistance of Nadia Gunraj in data collection. L. Lipscombe was supported by the Canadian Diabetes Association’s Marsha Howarth-Schwarz Postgraduate Fellowship. J. McLaughlin was supported as an Investigator by the Canadian Institutes of Health Research. B. Zinman holds the Sam and Judy Pencer Family Chair in Diabetes Research at Mount Sinai Hospital, University of Toronto. P. Goodwin holds the Marvelle Koffler Chair in Breast Research at Mount Sinai Hospital, University of Toronto.

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Authors and Affiliations

  1. Institute for Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, ON, Canada, M4N 3M5

    Lorraine L. Lipscombe & Janet E. Hux

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

    Lorraine L. Lipscombe, Pamela J. Goodwin, Bernard Zinman & Janet E. Hux

  3. Women’s College Hospital, Toronto, ON, Canada

    Lorraine L. Lipscombe

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

    Pamela J. Goodwin, John R. McLaughlin & Janet E. Hux

  5. Mount Sinai Hospital, Toronto, ON, Canada

    Pamela J. Goodwin & Bernard Zinman

  6. Samuel Lunenfeld Research Institute, Toronto, ON, Canada

    Pamela J. Goodwin, Bernard Zinman & John R. McLaughlin

  7. Cancer Care Ontario, Toronto, ON, Canada

    John R. McLaughlin

  8. Sunnybrook and Women’s College Health Sciences Centre, Toronto, ON, Canada

    Janet E. Hux

Authors
  1. Lorraine L. Lipscombe
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  2. Pamela J. Goodwin
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  3. Bernard Zinman
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  4. John R. McLaughlin
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  5. Janet E. Hux
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Correspondence to Lorraine L. Lipscombe.

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Lipscombe, L.L., Goodwin, P.J., Zinman, B. et al. The impact of diabetes on survival following breast cancer. Breast Cancer Res Treat 109, 389–395 (2008). https://doi.org/10.1007/s10549-007-9654-0

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