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Type 2 diabetes as a predictor of survival among breast cancer patients: the multiethnic cohort

  • Epidemiology
  • Published:
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Abstract

Purpose

The purpose of the study was to investigate the association of type 2 diabetes (T2D) with survival of breast cancer (BC) patients across five ethnic groups within the Multiethnic Cohort study.

Methods

Between recruitment in 1993–1996 and 2013, 7570 incident BC cases were identified through SEER cancer registries in Hawaii and California. T2D diagnosed before BC was ascertained in 1013 women from self-reports and confirmed by administrative data sources. Covariate information was collected by questionnaire. Cox regression analysis with age as the time metric and BMI as time-varying exposure was applied to estimate hazard ratios (HR) and 95% confidence intervals (CI) for BC-specific and all-cause survival while adjusting for known prognostic factors.

Results

In total, 2119 all-cause and 730 BC-specific deaths were recorded with corresponding 5-year survival rates of 86 and 93%. T2D was not a significant predictor of BC-specific survival (HR 0.84; 95% CI 0.65–1.09), but mortality was 36% lower for those with < 7 years of T2D than a longer history of T2D. On the other hand, all-cause mortality was higher in women with T2D (HR 1.23; 95% CI 1.08–1.40), especially in women with T2D of ≥ 7 years duration (HR 1.27; 95% CI 1.07–1.49). In women receiving none or either chemotherapy or radiation but not both, T2D predicted higher all-cause mortality (Pinteraction = 0.004). Variations in the association of T2D with mortality across ethnic groups were small.

Conclusions

T2D was associated with higher all-cause but not BC-specific mortality among women with BC in the Multiethnic Cohort study. However, T2D affected survival in cases who did not receive both radiation and chemotherapy.

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Data availability

The data underlying this study cannot be made publicly available because they contain patient identifying information. Data are available from the Multiethnic Cohort (MEC) study (http://www.uhcancercenter.org/research/the-multiethnic-cohort-study-mec/data-sharing-mec) for researchers who meet the criteria for access to confidential data. For details and to request application template please contact Gail Ichida, gichida@cc.hawaii.ed.

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Funding

The work within the Multiethnic Cohort was supported by the following Grants from the National Institutes of Health: R37CA54281 (L.N. Kolonel), U01CA164973 (L. Le Marchand, L.R. Wilkens, C.A. Haiman), R21 DK073816 (G. Maskarinec).

Author information

Authors and Affiliations

  1. Cancer Epidemiology, University of Hawaii Cancer Center, 701 Ilalo Street, Honolulu, Hi, 96813, USA

    Gertraud Maskarinec, Yurii B. Shvetsov & Loïc Le Marchand

  2. Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA, USA

    Shannon M. Conroy

  3. Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Christopher A. Haiman & Veronica W. Setiawan

Authors
  1. Gertraud Maskarinec
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  2. Yurii B. Shvetsov
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  3. Shannon M. Conroy
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  4. Christopher A. Haiman
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  5. Veronica W. Setiawan
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  6. Loïc Le Marchand
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Corresponding author

Correspondence to Gertraud Maskarinec.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The Multiethnic Study was approved by the Institutional Review Boards at the University of Hawaii and the University of Southern California and all aspects of the investigation complied with current rules for research involving Human Subjects.

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Maskarinec, G., Shvetsov, Y.B., Conroy, S.M. et al. Type 2 diabetes as a predictor of survival among breast cancer patients: the multiethnic cohort. Breast Cancer Res Treat 173, 637–645 (2019). https://doi.org/10.1007/s10549-018-5025-2

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  • DOI: https://doi.org/10.1007/s10549-018-5025-2

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