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Postmenopausal breast cancer survivors more likely to develop diabetes
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Women with diabetes have approximately a 20% greater risk for postmenopausal breast cancer and a 50% increased mortality rate after breast cancer diagnosis. However, few associations have been made regarding the incidence of diabetes among postmenopausal breast cancer survivors, recent data indicate.
To examine the potential link, Lorraine L. Lipscombe, MD, MSc, of Women’s College Hospital in Ontario, Canada, and colleagues used population-based data, and those patients with breast cancer were identified using the Ontario Cancer Registry. Additional patient data were obtained from the Ontario Diabetes Database.
The researchers studied 24,976 women with newly diagnosed breast cancer (mean age, 68.5 years) and age-matched the patients to 124,880 women without breast cancer. Researchers wrote that of the breast cancer survivors and matched control group, 9.7% developed diabetes during a mean follow-up of 5.8 years.
According to data, the risk for diabetes in breast cancer survivors compared with women without breast cancer increased 2 years after diagnosis (HR=1.07; 95% CI, 1.02-1.12). After 10 years of follow-up, this risk increased again (HR=1.21; 95% CI 1.09-1.35).
“It is possible that chemotherapy treatment may bring out diabetes earlier in susceptible women. Increased weight gain has been noted in the setting for adjuvant chemotherapy for breast cancer, which may be a factor in the increased risk of diabetes in women receiving treatment. Oestrogen suppression as a result of chemotherapy may also promote diabetes; however, this may have been less of a factor in this study where most women were already postmenopausal,” Lipscombe said in a press release.
The researchers wrote that the risk for diabetes was greater in the first 2 years after diagnosis (HR=1.24; 95% CI, 1.12-1.38) in those who underwent adjuvant chemotherapy (n=4,404). However, this increase declined by the 10-year follow-up (HR=1.08; 95% CI, 0.79-1.48).
Subsequently, researchers determined that the small increase depended upon whether patients received adjuvant chemotherapy. One major limitation included a lack of information on specific chemotherapeutic agents, which could have potential metabolic effects.
Despite these findings, the researchers wrote that there is a need for improved diabetes screening and prevention strategies for breast cancer survivors.
Disclosure: The researchers report no relevant financial disclosures.
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Michelle P. Warren, MD
This is an interesting study showing an increase in diabetes mellitus in patients with breast cancer particularly in the first 2 years after diagnosis and if they received adjuvant chemotherapy. The effect is thought to be due to insulin resistance, which is undoubtedly present when these patients are diagnosed. Weight gain and BMI at baseline are important variables that are not available. Patients who are diagnosed with breast cancer should be followed for this possible complication and this association bears further study.
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