Abstract
Purpose
This study assessed the association between the severity of diabetes complications using diabetes complications severity index (DCSI) and stage of breast cancer (BC) at diagnosis among elderly women with pre-existing diabetes and incident BC.
Methods
Using Surveillance, Epidemiology and End Results-Medicare data, we identified women with incident BC during 2004–2011 and pre-existing diabetes (N = 7729). Chi-square tests were used to test for group differences in stage of BC at diagnosis. Multinomial logistic regression was used to examine the associations between the severity of diabetes complications and stage of BC at diagnosis.
Results
Overall, women with a DCSI = 2 and a DCSI ≥ 3 were more likely to be diagnosed at advanced stages as compared to those with no diabetes complications. In full adjusted association (after adding BC screening to the analysis model), the severity of diabetes complications was no longer an independent predictor of advanced stages at diagnosis. However, women with a DCSI = 2 were 26% more likely to be diagnosed at stage I (versus stage 0) of BC at diagnosis as compared to those without diabetes complications (OR 1.26, 95% CI 1.03–1.53).
Conclusion
The increased likelihood of having advanced-stage BC at diagnosis associated with severity of diabetes-related complications appears to be mediated by lower rates of breast cancer screening among elderly women with pre-existing diabetes complications. Therefore, reducing disparity in receiving breast cancer screening among elderly women with diabetes may reduce the risk of advanced-stage breast cancer diagnosis.
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References
van de Poll-Franse LV, Houterman S, Janssen-Heijnen ML, Dercksen MW, Coebergh JW, Haak HR (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
Luo J, Hendryx M, Virnig B et al (2015) Pre-existing diabetes and breast cancer prognosis among elderly women. Br J Cancer 113(5):827–832
Lipscombe LL, Fischer HD, Austin PC et al (2015) The association between diabetes and breast cancer stage at diagnosis: a population-based study. Breast Cancer Res Treat 150(3):613–620
Giovannucci E, Harlan DM, Archer MC et al (2010) Diabetes and cancer: a consensus report. Diabetes Care 33:1674–1685
Lipscombe LL, Hux JE, Booth GL (2005) Reduced screening mammography among women with diabetes. Arch Intern Med 165(18):2090–2095
Khan SA, Stewart AK, Morrow M (2002) Does aggressive local therapy improve survival in metastatic breast cancer? Surgery 132(4):620–626 discussion 626-627
Freyer G, Braud AC, Chaibi P et al (2006) Dealing with metastatic breast cancer in elderly women: results from a French study on a large cohort carried out by the ‘Observatory on Elderly Patients’. Ann Oncol 17(2):211–216
Corriere M, Rooparinesingh N, Kalyani RR (2013) Epidemiology of diabetes and diabetes complications in the elderly: an emerging public health burden. Curr Diabetes Rep. 13(6):805–813
About SEER-Medicare Data Files. http://healthcaredelivery.cancer.gov/seermedicare/aboutdata/. Accessed 16 Dec 2016
Brief Description of SEER-Medicare Database. http://healthcaredelivery.cancer.gov/seermedicare/overview/. Accessed 26 Jan 2017
How the SEER & Medicare Data are Linked. http://healthcaredelivery.cancer.gov/seermedicare/overview/linked.html. Accessed 26 Jan 2017
AHRF: Area Health Resources Files. http://ahrf.hrsa.gov/. Accessed 12 January 2017
Luo J, Lin H-C, He K, Hendryx M (2014) Diabetes and prognosis in older persons with colorectal cancer. Br J Cancer 110(7):1847–1854
Young BA, Lin E, Von Korff M et al (2008) Diabetes complications severity index and risk of mortality, hospitalization, and healthcare utilization. Am J Manag Care 14(1):15–23
Chang HY, Weiner JP, Richards TM, Bleich SN, Segal JB (2012) Predicting costs with diabetes complications severity index in claims data. Am J Manag Care 18(4):213–219
Chen HL, Hsiao FY (2014) Risk of hospitalization and healthcare cost associated with Diabetes Complication Severity Index in Taiwan’s National Health Insurance Research Database. J Diabetes Complicat 28(5):612–616
Garwood CL, Korkis B, Mohammad I, Lepczyk M, Risko K (2016) Implementation of chronic care management services in primary care practice. Am J Health Syst Pharm 73(23):1924–1932
Warren JL, Klabunde CN, Schrag D, Bach PB, Riley GF (2002) Overview of the SEER-Medicare data: content, research applications, and generalizability to the United States elderly population. Med Care 40(8 Suppl):IV-3–IV-18
Chang HY, Weiner JP, Richards TM, Bleich SN, Segal JB (2012) Validating the adapted Diabetes Complications Severity Index in claims data. Am J Manag Care 18(11):721–726
Harris MI, Eastman RC (2000) Early detection of undiagnosed diabetes mellitus: a US perspective. Diabetes Metab Res Rev 16(4):230–236
Acknowledgements
We acknowledge the efforts of the National Cancer Institute, Centers for Medicare and Medicaid Services, Information Management Services, and the SEER program tumor registries in the creation of this database. We thank Dr. Charles D. Ponte and Dr. Usha Sambamoorthi for their review and feedback in an earlier version of this manuscript.
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Alenzi, E.O., Madhavan, S. & Tan, X. Association of the severity of diabetes-related complications with stage of breast cancer at diagnosis among elderly women with pre-existing diabetes. Breast Cancer Res Treat 167, 183–193 (2018). https://doi.org/10.1007/s10549-017-4477-0
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DOI: https://doi.org/10.1007/s10549-017-4477-0