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Ethnic differences in the relationships between diabetes, early age adiposity and mortality among breast cancer survivors: the Breast Cancer Health Disparities Study

  • Epidemiology
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Abstract

The contribution of type 2 diabetes and obesity on mortality in breast cancer (BC) patients has not been well studied among Hispanic women, in whom these exposures are highly prevalent. In a multi-center population-based study, we examined the associations between diabetes, multiple obesity measures, and mortality in 1180 Hispanic and 1298 non-Hispanic white (NHW) women who were diagnosed with incident invasive BC from the San Francisco Bay Area, New Mexico, Utah, Colorado, and Arizona. Adjusted hazard ratios (HR) and 95 % confidence intervals (CI) were calculated using Cox proportional hazards regression models. The median follow-up time from BC diagnosis to death was 10.8 years. In ethnic-stratified results, the association for BC-specific mortality among Hispanics was significantly increased (HR 1.85 95 % CI 1.11, 3.09), but the ethnic interaction was not statistically significant. In contrast, obesity at age 30 increased BC-specific mortality risk in NHW women (HR 2.33 95 % CI 1.36, 3.97) but not Hispanics (p-interaction = 0.045). Although there were no ethnic differences for all-cause mortality, diabetes, obesity at age 30, and post-diagnostic waist-hip ratio were significantly associated with all-cause mortality in all women. This study provides evidence that diabetes and adiposity, both modifiable, are prognostic factors among Hispanic and NHW BC patients.

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Abbreviations

4-CBCS:

4-Corners Breast Cancer Study

BMI:

Body mass index

BC-specific:

Breast cancer-specific

BCHDS:

Breast Cancer Health Disparities Study

ER/PR:

Estrogen and progesterone receptor

MBCS:

Mexico Breast Cancer Study

NHW:

Non-Hispanic white

SFBCS:

San Francisco Bay Area Breast Cancer Study

SEER:

Surveillance, Epidemiology, and End Results

WC:

Waist circumference

WHR:

Waist-hip ratio

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Acknowledgments

We would like to acknowledge the contributions of the following individuals to the study: Jennifer Herrick and Sandra Edwards for data harmonization oversight; Erica Wolff and Michael Hoffman for laboratory support; Jocelyn Koo for data management for the San Francisco Bay Area Breast Cancer Study, Dr. Tim Byers and Dr. Anna R. Giuliano for their contributions to the 4-Corners Breast Cancer Study, and Dr. Josh Galanter for assistance in selection of AIMs markers for the study.

Funding

The work was supported by Grant CA14002 from the National Cancer Institute. The San Francisco Bay Area Breast Cancer Study was supported by Grants CA63446 and CA77305 from the National Cancer Institute, Grant DAMD17-96-1-6071 from the U.S. Department of Defense and Grant 7PB-0068 from the California Breast Cancer Research Program. The collection of cancer incidence data used in this study was supported by the California Department of Public Health as part of the state-wide cancer reporting program mandated by California Health and Safety Code Section 103,885; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under contract HHSN261201000036C awarded to the Cancer Prevention Institute of California; and the Centers for Disease Control and Prevention’s National Program of Cancer Registries, under agreement #1U58 DP000807-01 awarded to the Public Health Institute. The 4-Corners Breast Cancer Study was funded by Grants CA078682, CA078762, CA078552, and CA078802 from the National Cancer Institute. The research also was supported by the Utah Cancer Registry, which is funded by contract N01-PC-67,000 from the National Cancer Institute, with additional support from the State of Utah Department of Health, the New Mexico Tumor Registry, and the Arizona and Colorado cancer registries, funded by the Centers for Disease Control and Prevention National Program of Cancer Registries and additional state support. The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official view of the National Cancer Institute or endorsement by the State of California Department of Public Health, the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors.

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Authors and Affiliations

  1. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Office E-6137, Baltimore, MD, USA

    Avonne E. Connor & Kala Visvanathan

  2. Department of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, 21205, USA

    Avonne E. Connor & Kala Visvanathan

  3. Department of Epidemiology and Population Health, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA

    Kathy B. Baumgartner, Richard N. Baumgartner & Stephanie D. Boone

  4. Department of Biology, University of Colorado, Colorado Springs, Colorado Springs, CO, USA

    Lisa M. Hines

  5. Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA

    Roger K. Wolff & Martha L. Slattery

  6. Department of Health Research and Policy (Epidemiology), and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA

    Esther M. John

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  1. Avonne E. Connor
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  2. Kala Visvanathan
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  3. Kathy B. Baumgartner
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  4. Richard N. Baumgartner
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  5. Stephanie D. Boone
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  6. Lisa M. Hines
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  7. Roger K. Wolff
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  8. Esther M. John
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  9. Martha L. Slattery
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Correspondence to Avonne E. Connor.

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Connor, A.E., Visvanathan, K., Baumgartner, K.B. et al. Ethnic differences in the relationships between diabetes, early age adiposity and mortality among breast cancer survivors: the Breast Cancer Health Disparities Study. Breast Cancer Res Treat 157, 167–178 (2016). https://doi.org/10.1007/s10549-016-3810-3

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