Breast Cancer Research and Treatment

, Volume 146, Issue 1, pp 199–209 | Cite as

The influence of diabetes severity on receipt of guideline-concordant treatment for breast cancer

  • Susan A. Sabatino
  • Trevor D. Thompson
  • Xiao-Cheng Wu
  • Steven T. Fleming
  • Gretchen G. Kimmick
  • Amy Trentham-Dietz
  • Rosemary Cress
  • Roger T. Anderson


Diabetes severity may influence breast cancer treatment choices. We examined whether receipt of guideline-concordant breast cancer treatment varied with diabetes severity. Cancer registry data from seven states regarding 6,912 stage I–III breast cancers were supplemented by medical record abstraction and physician verification. We used logistic regression models to examine associations of diabetes severity with guideline-concordant locoregional treatment, adjuvant chemotherapy, and hormonal therapy adjusted for sociodemographics, comorbidity, and tumor characteristics. We defined guideline concordance using National Comprehensive Cancer Network guidelines, and diabetes and comorbidities using the Adult Comorbidity Evaluation-27 index. After adjustment, there was significant interaction of diabetes severity with age for locoregional treatment (p = 0.001), with many diabetic women under age 70 less frequently receiving guideline-concordant treatment than non-diabetic women. Among similarly aged women, guideline concordance was lower for women with mild diabetes in their late fifties through mid-sixties, and with moderate/severe diabetes in their late forties to early sixties. Among women in their mid-seventies to early eighties, moderate/severe diabetes was associated with increased guideline concordance. For adjuvant chemotherapy, moderate/severe diabetes was less frequently associated with guideline concordance than no diabetes [OR 0.58 (95 % CI 0.36–0.94)]. Diabetes was not associated with guideline-concordant hormonal treatment (p = 0.929). Some diabetic women were less likely to receive guideline-concordant treatment for stage I–III breast cancer than non-diabetic women. Diabetes severity was associated with lower guideline concordance for locoregional treatment among middle-aged women, and lower guideline concordance for adjuvant chemotherapy. Differences were not explained by comorbidity and may contribute to potentially worse breast cancer outcomes.


Breast cancer Diabetes Cancer treatment Surgery Radiation Chemotherapy Hormonal therapy 



The data used for this publication were collected by the Centers for Disease Control and Prevention’s (CDC) National Program of Cancer Registries (NPCR) Patterns of Care Study for Breast and Prostate Cancers (POCBP), which was funded by CDC through cooperative agreements with the participating state cancer registries. Dr. Sabatino and Mr. Thompson are employees of the Centers for Disease Control and Prevention. This manuscript is written on behalf of the POCBP Group. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Conflict of interest

Dr. Trentham-Dietz reported receiving funding from the Centers for Disease Control and Prevention. Dr. Anderson reported serving in a consultant/advisory role for Bayer and Abbott. Dr. Kimmick reported receiving remuneration from Genomic Health, Astra Zeneca, Pfizer and Novartis, serving in a consultant/advisory role for Genomic Health, Astra Zeneca, Pfizer and Novartis, and receiving funding from Astra Zeneca, Roche, Wyeth, Bristol-Meyers-Squibb, GlaxoSmithKline, and Bionovo. Dr. Sabatino reported stock ownership in Pfizer and a healthcare index fund. The remaining coauthors declared no conflict of interest.


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Copyright information

© Springer Science+Business Media New York (outside the USA) 2014

Authors and Affiliations

  • Susan A. Sabatino
    • 1
  • Trevor D. Thompson
    • 1
  • Xiao-Cheng Wu
    • 2
  • Steven T. Fleming
    • 3
  • Gretchen G. Kimmick
    • 4
  • Amy Trentham-Dietz
    • 5
  • Rosemary Cress
    • 6
    • 7
  • Roger T. Anderson
    • 8
  1. 1.Division of Cancer Prevention and ControlCenters for Disease Control and PreventionAtlantaUSA
  2. 2.Epidemiology Program, School of Public HealthLSU Health Sciences CenterNew OrleansUSA
  3. 3.Department of EpidemiologyUniversity of Kentucky College of Public HealthLexingtonUSA
  4. 4.Internal Medicine, Medical Oncology, Multidisciplinary Breast ProgramDuke University Medical CenterDurhamUSA
  5. 5.Department of Population Health Sciences and Paul P. Carbone Comprehensive Cancer CenterUniversity of WisconsinMadisonUSA
  6. 6.Public Health InstituteCancer Registry of Greater CaliforniaSacramentoUSA
  7. 7.Department of Public Health SciencesUC Davis School of MedicineDavisUSA
  8. 8.Pennsylvania State College of MedicineHersheyUSA

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