Skip to main content

Advertisement

SpringerLink
Log in

Diabetes and breast cancer mortality in Black women

  • Original paper
  • Published:
Cancer Causes & Control Aims and scope Submit manuscript

Abstract

Purpose

Breast cancer mortality is higher in Black women than in White women. The prevalence of type 2 diabetes mellitus is also higher, yet data on whether diabetes affects breast cancer mortality in this population are lacking. We investigated the relation of diabetes at the time of breast cancer diagnosis to breast cancer mortality in the Black Women’s Health Study, a prospective cohort study.

Methods

1,621 Black women with invasive breast cancer diagnosed in 1995–2013 were followed by mailed questionnaires and searches of the National Death Index. Multivariable Cox regression analysis was used to compute hazard ratios (HRs) for diabetes in relation to breast cancer mortality and all-cause mortality, with adjustment for age, stage, treatment modality, estrogen receptor (ER) status, and body mass index.

Results

There were 368 deaths during follow-up, of which 273 were due to breast cancer. Breast cancer mortality was significantly increased in women who had been diagnosed with diabetes at least 5 years before breast cancer occurrence, HR 1.86 (95% CI 1.20–2.89), with elevations observed for both ER+ and ER− breast cancer. All-cause mortality was also higher in diabetics, with HRs of 1.54 (95% CI 1.12–2.07) overall and 2.26 (95% CI 1.62–3.15) for ≥5-year duration of diabetes relative to non-diabetics.

Conclusions

Our results present the first solid evidence of a positive association of type 2 diabetes with breast cancer mortality in Black women. Given the higher prevalence and earlier onset of type 2 diabetes in Black women, it is likely that diabetes contributes to racial disparities in breast cancer mortality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. American Cancer Society (2013) Breast cancer facts and figures 2013–2014. American Cancer Society, Atlanta

    Google Scholar 

  2. Centers for Disease Control and Prevention (2014) National diabetes statistics report: estimates of diabetes and its burden in the United States, 2014. U.S. Department of Health and Human Services, Atlanta

    Google Scholar 

  3. Erickson K, Patterson RE, Flatt SW, Natarajan L, Parker BA, Heath DD et al (2011) Clinically defined type 2 diabetes mellitus and prognosis in early-stage breast cancer. J Clin Oncol 29:54–60

    Article  PubMed  Google Scholar 

  4. Goodwin PJ, Ennis M, Pritchard KI, Trudeau ME, Koo J, Madarnas Y et al (2002) Fasting insulin and outcome in early-stage breast cancer: results of a prospective cohort study. J Clin Oncol 20:42–51

    Article  CAS  PubMed  Google Scholar 

  5. Luo J, Virnig B, Hendryx M, Wen S, Chelebowski R, Chen C et al (2014) Diabetes, diabetes treatment and breast cancer prognosis. Breast Cancer Res Treat 148:153–162

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Patterson RE, Flatt SW, Saquib N, Rock CL, Caan BJ, Parker BA et al (2010) Medical comorbidities predict mortality in women with a history of early stage breast cancer. Breast Cancer Res Treat 122:859–865

    Article  PubMed  PubMed Central  Google Scholar 

  7. Peairs KS, Barone BB, Snyder CF, Yeh HC, Stein KB, Derr RL et al (2011) Diabetes mellitus and breast cancer outcomes: a systematic review and meta-analysis. J Clin Oncol 29:40–46

    Article  PubMed  Google Scholar 

  8. Schrauder MG, Fasching PA, Haberle L, Lux MP, Rauh C, Hein A et al (2011) Diabetes and prognosis in a breast cancer cohort. J Cancer Res Clin Oncol 137:975–983

    Article  PubMed  Google Scholar 

  9. Wu AH, Kurian AW, Kwan ML, John EM, Lu Y, Keegan TH et al (2015) Diabetes and other comorbidities in breast cancer survival by race/ethnicity: the California Breast Cancer Survivorship Consortium (CBCSC). Cancer Epidemiol Biomark Prev 24:361–368

    Article  CAS  Google Scholar 

  10. Srokowski TP, Fang S, Hortobagyi GN, Giordano SH (2009) Impact of diabetes mellitus on complications and outcomes of adjuvant chemotherapy in older patients with breast cancer. J Clin Oncol 27:2170–2176

    Article  PubMed  PubMed Central  Google Scholar 

  11. Coughlin SS, Calle EE, Teras LR, Petrelli J, Thun MJ (2004) Diabetes mellitus as a predictor of cancer mortality in a large cohort of US adults. Am J Epidemiol 159:1160–1167

    Article  PubMed  Google Scholar 

  12. Liu X, Ji J, Sundquist K, Sundquist J, Hemminki K (2012) The impact of type 2 diabetes mellitus on cancer-specific survival: a follow-up study in Sweden. Cancer 118:1353–1361

    Article  PubMed  Google Scholar 

  13. Krishnan S, Rosenberg L, Djousse L, Cupples LA, Palmer JR (2007) Overall and central obesity and risk of type 2 diabetes in U.S. black women. Obesity 15:1860–1866

    Article  PubMed  Google Scholar 

  14. Rosenberg L, Palmer JR, Wise LA, Adams-Campbell LL (2006) A prospective study of female hormone use and breast cancer among black women. Arch Intern Med 166:760–765

    Article  PubMed  Google Scholar 

  15. Wise LA, Rosenberg L, Radin RG, Mattox C, Yang EB, Palmer JR et al (2011) A prospective study of diabetes, lifestyle factors, and glaucoma among African-American women. Ann Epidemiol 21:430–439

    Article  PubMed  PubMed Central  Google Scholar 

  16. Palmer JR, Adams-Campbell LL, Boggs DA, Wise LA, Rosenberg L (2007) A prospective study of body size and breast cancer in black women. Cancer Epidemiol Biomark Prev 16:1795–1802

    Article  Google Scholar 

  17. Papa V, Costantino A, Belfiore A (1997) Insulin receptor what role in breast cancer? Trends Endocrinol Metab 8:306–312

    Article  CAS  PubMed  Google Scholar 

  18. Wolf I, Sadetzki S, Catane R, Karasik A, Kaufman B (2005) Diabetes mellitus and breast cancer. Lancet Oncol 6:103–111

    Article  CAS  PubMed  Google Scholar 

  19. Xue F, Michels KB (2007) Diabetes, metabolic syndrome, and breast cancer: a review of the current evidence. Am J Clin Nutr 86:s823–s835

    PubMed  Google Scholar 

Download references

Acknowledgments

We acknowledge the continued commitment of the Black Women’s Health Study (BWHS) participants. We also acknowledge the dedication and support of the BWHS data collection staff. The content is solely the responsibility of the authors and does not necessarily represent the official views of the American Cancer Society, National Cancer Institute, or the National Institutes of Health. Data on breast cancer pathology were obtained from several state cancer registries (AZ, CA, CO, CT, DE, DC, FL, GA, IL, IN, KY, LA, MD, MA, MI, NJ, NY, NC, OK, PA, SC, TN, TX, VA), and results reported do not necessarily represent their views.

Financial support

This work was supported by the National Institutes of Health, National Cancer Institute grants R01 CA058420 (LR), UM1 CA164974 (LR, JRP), P01 CA151135 (JRP), and U01 CA182898 (GVD, JRP); the Boston Medical Center Carter Disparity Endowment (MC); and the American Cancer Society Institutional Research Grant IRG-72-001-36-IRG (MC).

Author information

Authors and Affiliations

  1. Section of Hematology and Oncology, Department of Medicine, Evans Biomed Research Center, Boston University School of Medicine, 650 Albany Street, Suite 406, Boston, MA, 02118, USA

    Marjory Charlot

  2. Slone Epidemiology Center, Boston University, Boston, MA, USA

    Nelsy Castro-Webb, Traci N. Bethea, Kimberly Bertrand, Lynn Rosenberg & Julie R. Palmer

  3. Naval Health Research Center, Henry M. Jackson Foundation for the Advancement of Military Medicine, San Diego, CA, USA

    Deborah A. Boggs

  4. Departments of Medicine and Pharmacology, BU-BMC Cancer Center, Boston University School of Medicine, Boston, MA, USA

    Gerald V. Denis

  5. Cancer Prevention and Control, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA

    Lucile L. Adams-Campbell

Authors
  1. Marjory Charlot
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nelsy Castro-Webb
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Traci N. Bethea
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kimberly Bertrand
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Deborah A. Boggs
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gerald V. Denis
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Lucile L. Adams-Campbell
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Lynn Rosenberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Julie R. Palmer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marjory Charlot.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Charlot, M., Castro-Webb, N., Bethea, T.N. et al. Diabetes and breast cancer mortality in Black women. Cancer Causes Control 28, 61–67 (2017). https://doi.org/10.1007/s10552-016-0837-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10552-016-0837-z

Keywords

Search

Navigation