Diabetes and Overall Survival among Breast Cancer Patients in the U.S. Military Health System

Abstract

Background While research suggests that type 2 diabetes mellitus (DM-2) is associated with overall and breast cancer-specific decreased survival, most prior studies of breast cancer survival investigated the effect of pre-existing DM-2 without assessing the effect of DM-2 diagnosed at or after breast cancer diagnosis. This study examined the relationship between DM-2 diagnosed before and after breast cancer diagnosis and overall survival. Methods This study uses linked Department of Defense cancer registry and medical claims data from 9,398 women diagnosed with breast cancer between 1998 and 2007. Cox proportional hazards models were used to assess the association between DM-2 and overall survival. Results Our analyses showed that women with DM-2 diagnosed before breast cancer diagnosis tended to have a higher risk of mortality compared to women without diabetes (HR=1.17, 95% CI=0.95-1.44) after adjustment for potential confounders. Similarly, patients diagnosed with DM-2 at or after breast cancer diagnosis had increased mortality compared with women without DM-2 (HR= 1.39, 95% CI= 1.16-1.66). The similar tendency was also observed among most subgroups when results were stratified by race, menopausal status, obesity, tumor hormone receptor status, and stage. Conclusions Using data from a health system that provides universal healthcare to its beneficiaries, this study showed an increased risk of death associated with DM-2, regardless of whether it was diagnosed before or at/after breast cancer diagnosis. Impact: These results suggest the potential effects of factors independent of the timing of DM-2 clinical diagnosis on the association of DM-2 with overall survival.

Diabetes as a Risk Factor for Breast Cancer

“…In breast cancer patients with type 2 diabetes mellitus prior to diagnosis, the mortality rate is increased compared to individuals without diabetes (hazard ratio 1.17). The mortality increased further when type 2 diabetes mellitus was diagnosed at or after the breast cancer diagnosis (hazard ratio 1.39) [27].…”

Transgender individuals' cancer survivorship: Results of a cross‐sectional study

“…Comorbidities at the time of diagnosis may limit treatment options; in addition, the toxicity of cancer treatments is known to cause cardiovascular disease as a late effect, which is why many professional provider organizations have issued guidelines to manage cardiovascular disease in cancer survivors . Data have shown that a diagnosis of diabetes prior to or after a cancer diagnosis increases cancer survivors' mortality . Cardiovascular disease and diabetes are the most common comorbid conditions among cancer survivors, and comorbidities have a negative effect on cancer survivors' long‐term survival .…”

Post-diagnostic antipsychotic use and cancer mortality: a population based cohort study

“…Potential confounders included those measured at cohort entry including, year of cancer diagnosis and age. Co-morbid conditions have been noted to impact upon survival in cancer patients, including breast cancer [ 26 – 28 ], thus our models adjusted for various comorbities (defined at cohort entry) including cerebrovascular disease, chronic pulmonary disease, congestive heart disease, diabetes, liver disease, myocardial infarction, peptic ulcer disease, peripheral vascular disease, renal disease, identified using a list of Read codes modified for use in the CPRD) [ 29 ]. A history of severe mental illness (including schizophrenia-like disorders, bipolar-affective disorders and other non-organic psychoses such as delusional disorder, ‘psychoses not otherwise specified’ and severe depression with psychoses) was identified using Read codes, as used previously [ 1 ].…”