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Diabetes, diabetes treatment and breast cancer prognosis

  • Epidemiology
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Abstract

The objectives of this study are to assess the impact of pre-existing diabetes and diabetes treatment on breast cancer prognosis. 8,108 women with centrally confirmed invasive breast cancer in the Women’s Health Initiative diagnosed between 1998 and 2013 were followed through the date of death or September 20, 2013. Information on diabetes and diabetes therapy were obtained via self-report and face-to-face review of current medication containers, respectively. Cox proportional hazard regression was used to estimate adjusted relative hazard ratios for overall mortality. The proportional subdistribution hazard model was used to estimate hazard ratios for breast cancer-specific mortality. Compared with women without diabetes, women with diabetes had significantly increased risk of overall mortality (HR 1.26 95 % CI 1.06–1.48), especially among those who took insulin or had longer duration of diabetes. However, diabetes was not associated with increased risk of breast cancer-specific mortality, regardless of type of treatment and duration of diabetes, despite the significant association of diabetes with unfavorable tumor characteristics. Our large prospective cohort study provides additional evidence that pre-existing diabetes increases risk of total mortality among women with breast cancer. The increased total mortality associated with diabetes was mainly driven by increased risk of dying from diseases other than breast cancer. Thus, the continuum of care for breast cancer patients with diabetes should include careful attention to CVD risk factors and other non-cancer conditions.

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Acknowledgments

Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under Award Number R15CA179463. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.” The WHI program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services through contracts HHSN268201100046C, HHSN268201100001C, HHSN268201100002C, HHSN268201100003C, HHSN268201100004C, and HHSN271201100004C.” We also request that you consult www.whi.org for exact wording if you include a description of the WHI trials in your manuscript. A short list of WHI investigators appears in the appendix.

Conflict of interest

No potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, 1025 E. 7th Street, Bloomington, IN, 47405, USA

    Juhua Luo

  2. Division of Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA

    Beth Virnig

  3. Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, USA

    Michael Hendryx

  4. Department of Biostatistics, School of Public Health, West Virginian University, Morgantown, USA

    Sijin Wen

  5. Los Angeles BioMedical Research Institute at Harbor–University of California, Los Angeles, USA

    Rowan Chelebowski

  6. Torrance Memorial Medical Center, Torrance, CA, USA

    Rowan Chelebowski

  7. Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Chu Chen

  8. Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA

    Tomas Rohan

  9. Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Lesley Tinker

  10. Department of Social and Preventive Medicine, University at Buffalo, Buffalo, NY, USA

    Jean Wactawski-Wende

  11. George Washington University Medical Center, Washington, DC, USA

    Lawrence Lessin

  12. HealthPartners Institute for Education and Research, Box 1524, Mailstop, 21111R, Minneapolis, MN, USA

    Karen Margolis

Authors
  1. Juhua Luo
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  2. Beth Virnig
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  3. Michael Hendryx
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  4. Sijin Wen
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  5. Rowan Chelebowski
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  6. Chu Chen
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  7. Tomas Rohan
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  8. Lesley Tinker
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  9. Jean Wactawski-Wende
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  10. Lawrence Lessin
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  11. Karen Margolis
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Corresponding author

Correspondence to Juhua Luo.

Appendix: short list of whi investigators

Appendix: short list of whi investigators

  • Program Office (National Heart, Lung, and Blood Institute, Bethesda, Maryland) Jacques Rossouw, Shari Ludlam, Dale Burwen, Joan McGowan, Leslie Ford, and Nancy Geller

  • Clinical Coordinating Center (Fred Hutchinson Cancer Research Center, Seattle, WA) Garnet Anderson, Ross Prentice, Andrea LaCroix, and Charles Kooperberg

  • Investigators and Academic Centers (Brigham and Women’s Hospital, Harvard Medical School, Boston, MA) JoAnn E. Manson; (MedStar Health Research Institute/Howard University, Washington, DC) Barbara V. Howard; (Stanford Prevention Research Center, Stanford, CA) Marcia L. Stefanick; (The Ohio State University, Columbus, OH) Rebecca Jackson; (University of Arizona, Tucson/Phoenix, AZ) Cynthia A. Thomson; (University at Buffalo, Buffalo, NY) Jean Wactawski-Wende; (University of Florida, Gainesville/Jacksonville, FL) Marian Limacher; (University of Iowa, Iowa City/Davenport, IA) Robert Wallace; (University of Pittsburgh, Pittsburgh, PA) Lewis Kuller; (Wake Forest University School of Medicine, Winston-Salem, NC) Sally Shumaker

  • Women’s Health Initiative Memory Study (Wake Forest University School of Medicine, Winston-Salem, NC) Sally Shumaker

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Luo, J., Virnig, B., Hendryx, M. et al. Diabetes, diabetes treatment and breast cancer prognosis. Breast Cancer Res Treat 148, 153–162 (2014). https://doi.org/10.1007/s10549-014-3146-9

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