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Associations of type 2 diabetes and diabetes treatment with breast cancer risk and mortality: a population-based cohort study among British women

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Abstract

Purpose

There is great interest in whether type 2 diabetes and its treatments alter breast cancer risk and prognosis, but previous studies are inconclusive. We conducted a cohort study within the UK General Practice Research Database to investigate associations of type 2 diabetes and patterns of diabetes treatment with breast cancer risk and all-cause mortality.

Methods

We identified 52,657 women with type 2 diabetes, diagnosed between 1987 and 2007, and 30,210 randomly selected women without diabetes. We performed a time-dependent analysis using Cox proportional hazards models.

Results

Diabetes was associated with a 29 % increased overall breast cancer risk (95 % CI: 1.16–1.44), but the association markedly attenuated when adjusted for age, period of cohort entry, region, and body mass index (BMI) (HR: 1.12; 95 % CI: 0.98–1.29). Women with breast cancer and pre-existing diabetes had a 49 % (95 % CI: 1.17–1.88) increased all-cause mortality risk compared with women with breast cancer but without diabetes, after controlling for age, period, region, BMI, smoking, alcohol, and deprivation. Compared with sulfonylurea, we found weak evidence that metformin monotherapy (HR: 1.04; 95 % CI: 0.79–1.37) and insulin (HR: 1.33; 95 % CI: 0.63–2.83) modified breast cancer risk among women with diabetes.

Conclusions

We found weak evidence that diabetes is associated with a small increased risk of breast cancer. Among treated women, there is no evidence that anti-diabetes treatments modify the risk of developing breast cancer, with wide confidence intervals indicating imprecise effect estimates. Women with breast cancer and diabetes, however, had an increased all-cause mortality risk highlighting the potential importance of maintaining adequate glycemic control alongside anti-cancer treatments and subsequent follow-up.

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Acknowledgments

We would like to thank Prof. Edwin Gale of the Department of Diabetes and Metabolism, Medical School Unit, Southmead Hospital, Bristol, for his inputs in the development of this manuscript. This study is based on data from the Full Feature General Practice Research Database obtained under license from the UK Medicines and Healthcare Products Regulatory Agency (MHRA). However, the interpretation and conclusions contained in this study are those of the authors alone. Access to the General Practice Research Database (GPRD) was funded through the Medical Research Council (MRC) license agreement with the UK Medicines and Healthcare Products Regulatory Agency.

Conflict of interest

The authors declare that they have to conflict of interest.

Ethical approval

This study was approved by the Independent Scientific Advisory Committee (ISAC) of the MHRA. All observational studies performed using GPRD data are covered by the favorable ethical review of the Trent Multi-Centre Research Ethics Committee (05/MRE04/87).

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Authors and Affiliations

  1. School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK

    Maria Theresa M. Redaniel, Mona Jeffreys, Margaret T. May, Yoav Ben-Shlomo & Richard M. Martin

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  1. Maria Theresa M. Redaniel
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  2. Mona Jeffreys
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  3. Margaret T. May
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  4. Yoav Ben-Shlomo
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  5. Richard M. Martin
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Corresponding author

Correspondence to Maria Theresa M. Redaniel.

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Redaniel, M.T.M., Jeffreys, M., May, M.T. et al. Associations of type 2 diabetes and diabetes treatment with breast cancer risk and mortality: a population-based cohort study among British women. Cancer Causes Control 23, 1785–1795 (2012). https://doi.org/10.1007/s10552-012-0057-0

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