Cancer Causes & Control

, Volume 30, Issue 5, pp 425–433 | Cite as

Diabetes, obesity, and subsequent risk of postmenopausal breast cancer among white and black women in the Southern Community Cohort Study

  • Maureen SandersonEmail author
  • Loren Lipworth
  • Martha J. Shrubsole
  • Shaneda Warren Andersen
  • Xiao-Ou Shu
  • Wei Zheng
  • Margaret K. Hargreaves
  • William J. Blot
Original Paper



Meta-analyses have reported a small but positive association between diabetes and postmenopausal breast cancer risk, with summary relative risks of approximately 1.15. We analyzed data from the Southern Community Cohort Study (SCCS) following an underserved population with high diabetes prevalence to prospectively examine whether diabetes was associated with subsequent postmenopausal breast cancer risk and whether obesity modified this effect.


Women with incident breast cancer were identified through linkage with state cancer registries and the National Death Index (213 white, 418 black cases). Person-years were calculated from date of entry into the SCCS until the earliest of date of breast cancer diagnosis, date of death, or date of last follow-up (8,277 white, 16,458 black noncases). Data on diabetes diagnosis were obtained through baseline and follow-up surveys. Cox regression was applied to examine the association between diabetes and postmenopausal breast cancer risk.


After adjustment for confounding, there was no association between self-reported diabetes and postmenopausal breast cancer risk among white (hazard ratio [HR] 1.02, 95% confidence interval [CI] 0.75–1.40) or black (HR 1.00, 95% CI 0.81–1.22) women. Nor was there evidence that obesity modified the effect of diabetes on postmenopausal breast cancer in women of either race.


We found no evidence of the hypothesized increased risk of breast cancer among women with diabetes. The breast cancer risks among those with diabetes in this population suggest that the association between these two illnesses is complex.


Postmenopausal breast cancer Diabetes Obesity Prospective cohort study 



The Southern Community Cohort Study was supported by the National Cancer Institute (Grants R01 CA092447 and U01 CA202979). Dr. Warren Andersen is supported by R00 CA207848. Data collection performed by the Survey and Biospecimen Shared Resource is supported in part by the Vanderbilt-Ingram Cancer Center (P30 CA68485).

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Xue F, Michels KB (2007) Diabetes, metabolic syndrome, and breast cancer: a review of the current evidence. Am J Clin Nutr 86(suppl):832S–835SGoogle Scholar
  2. 2.
    Wolf I, Sadetzki S, Catane R, Karasik A, Kaufman B (2005) Diabetes mellitus and breast cancer. Lancet Oncol 6:103–111CrossRefGoogle Scholar
  3. 3.
    Larsson SC, Mantzoros CS, Wolk A (2007) Diabetes mellitus and risk of breast cancer: a meta-analysis. Int J Cancer 121:856–862CrossRefGoogle Scholar
  4. 4.
    Liao S, Li J, Wei W, Wang L, Zhang Y, Li J, Wang C, Sun S (2011) Association between diabetes mellitus and breast cancer risk: a meta-analysis of the literature. Asian Pac J Cancer Prev 12:1061–1065Google Scholar
  5. 5.
    Boyle P, Boniol M, Koechlin A, Robertson C, Valentini F, Coppens K, Fairley LL, Boniol M, Zheng T, Zhang Y, Pasterk M, Smans M, Curado MP, Mullie P, Gandini S, Bota M, Bolli GB, Rosenstock J, Autier P (2012) Diabetes and breast cancer risk: a meta-analysis. Br J Cancer 107:1608–1617CrossRefGoogle Scholar
  6. 6.
    Maskarinec G, Jacobs S, Park S-Y, Haiman CA, Setiawan VW, Wilkens LR, Le Marchand L (2017) Type II diabetes, obesity, and breast cancer risk: the Multiethnic Cohort. Cancer Epidemiol Biomarkers Prev 26(6):854–861CrossRefGoogle Scholar
  7. 7.
    Palmer JR, Castro-Webb N, Bertrand K, Bethea TN, Denis GV (2017) Type II diabetes and incidence of estrogen receptor negative breast cancer in African American women. Cancer Res 77:6462–6469CrossRefGoogle Scholar
  8. 8.
    La Vecchia C, Giordano SH, Hortobagyi GN, Chabner B (2011) Overweight, obesity, diabetes, and risk of breast cancer: interlocking pieces of the puzzle. Oncologist 16:726–729CrossRefGoogle Scholar
  9. 9.
    Bowker SL, Richardson K, Marra CA, Johnson JA (2011) Risk of breast cancer after onset of type 2 diabetes. Diabetes Care 34:2542–2544CrossRefGoogle Scholar
  10. 10.
    Sanderson M, Lipworth L, Han X, Beeghly-Fadiel A, Shen-Miller D, Patel K, Blot WJ, Hargreaves MK (2014) Mammography use among women with and without diabetes: results from the Southern Community Cohort Study. J Epidemiol Glob Health 4(3):223–230CrossRefGoogle Scholar
  11. 11.
    Checkley LA, Rudolph MC, Wellberg EA, Giles ED, Wahdan-Alaswad RS, Houck JA, Edgerton SM, Thor AD, Schedin P, Anderson SM, MacLean PS (2017) Metformin accumulation correlates with organic cation transporter 2 protein expression and predicts mammary tumor regression in vivo. Cancer Prev Res 10(3):198–207CrossRefGoogle Scholar
  12. 12.
    Tang GH, Satkunam M, Pond GR, Steinberg GR, Blandino G, Schunemann HJ, Muti P (2018) Association of metformin with breast cancer incidence and mortality in patients with Type II diabetes: a GRADE-assessed systematic review and meta-analysis. Cancer Epidemiol Biomarkers Prev 27(6):627–635CrossRefGoogle Scholar
  13. 13.
    Signorello LB, Hargreaves MK, Blot WJ (2010) The Southern Community Cohort Study: investigating health disparities. J Health Care Poor Underserved 21:26–37CrossRefGoogle Scholar
  14. 14.
    Cohen SS, Matthews CE, Bradshaw PT, Lipworth L, Buchowski MS, Signorello LB, Blot WJ (2013) Sedentary behavior, physical activity, and likelihood of breast cancer among Black and White women: a report from the Southern Community Cohort Study. Cancer Prev Res 6(6):566–576CrossRefGoogle Scholar
  15. 15.
    Conway BN, Han X, Munro HM, Gross AL, Shu X-O, Hargreaves MK, Zheng W, Powers AC, Blot WJ (2018) The obesity epidemic and rising diabetes incidence in a low-income racially diverse southern US cohort. PLoS ONE 13(1):e0190993CrossRefGoogle Scholar
  16. 16.
    Dupont WD (2009) Statistical modeling for biomedical researchers: a simple introduction to the analysis of complex data, 2nd edn. Cambridge University Press, Cambridge, pp 97–155CrossRefGoogle Scholar
  17. 17.
    Bosco JLF, Palmer JR, Boggs DA, Hatch EE, Rosenberg L (2012) Cardiometabolic factors and breast cancer risk in U.S. black women. Breast Cancer Res Treat 134:1247–1256CrossRefGoogle Scholar
  18. 18.
    Colmers IN, Bowker SL, Tjosvold LA, Johnson JA (2012) Insulin use and cancer risk in patients with type 2 diabetes: a systematic review and meta-analysis of observational studies. Diabetes Metab 38:485–506CrossRefGoogle Scholar
  19. 19.
    Morden NE, Liu SK, Smith J, Mackenzie TA, Skinner J, Korc M (2011) Further exploration of the relationship between insulin glargine and incident cancer: a retrospective cohort study of older Medicare patients. Diabetes Care 34:1965–1971CrossRefGoogle Scholar
  20. 20.
    Williams LK, Padhukasahasram B, Ahmedani BK, Peterson EL, Wells KE, Burchard EG, Lanfear DE (2014) Differing effects of metformin on glycemic control by race-ethnicity. J Clin Endocrinol Metab 99(9):3160–3168CrossRefGoogle Scholar
  21. 21.
    Michels KB, Solomon CG, Hu FB, Rosner BA, Hankinson SE, Colditz GA, Manson JE (2003) Type 2 diabetes and subsequent incidence of breast cancer in the Nurses’ Health Study. Diabetes Care 26:1752–1758CrossRefGoogle Scholar
  22. 22.
    Centers for Disease Control and Prevention (2017) National Diabetes Statistics Report, 2017. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Department of Health and Human ServicesGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Family and Community MedicineMeharry Medical CollegeNashvilleUSA
  2. 2.Division of Epidemiology, Department of MedicineVanderbilt University Medical CenterNashvilleUSA
  3. 3.Department of Population Health SciencesUniversity of Wisconsin-MadisonMadisonUSA
  4. 4.Department of Internal MedicineMeharry Medical CollegeNashvilleUSA

Personalised recommendations