Diabetes in relation to breast cancer relapse and all-cause mortality in elderly breast cancer patients: a FOCUS study analysis

Kiderlen, M.; Glas, Nienke A. de; Bastiaannet, E.; Engels, C.C.; Water, W. van de; Craen, Anton J. M. de; Portielje, Johanneke E.A.; Velde, Cornelis J.H. van de; Liefers, Gerrit‐Jan

doi:10.1093/annonc/mdt367

Cited by 45 publications

(41 citation statements)

References 24 publications

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“…Some epidemiological studies and meta-analysis have shown that metformin use is associated with decreased risk and /or reduced mortality of ovarian cancer (13)(14)(15)(16)(17) endometrial cancer (17,21,105,106) and breast cancer (22,131,132,135,136) .Metformin is especially useful for endometrial cancer prevention in women with PCOS and obesity (18,19,(97)(98)(99)(100)(101)(102)(103) and can represent a novel interesting treatment option for atypical endometrial hyperplasia or early stage, well differentiated endometrioid-type endometrial carcinoma in young women who wish to preserve fertility (94, 99,.101). As far as breast cancer is concerned, the heterogeneity of tumor subtypes makes it difficult to determine the actual benefits of metformin therapy (140) .…”

Section: Discussionmentioning

confidence: 99%

“…In a Danish case-control study including type 2 diabetic women aged >50 years, metformin users had a 23% risk reduction of developing breast cancer than non users (22) .Similarly a large cohort study showed that diabetic women who were given metformin had a 25% risk reduction, whereas diabetic women receiving drugs other than metformin had a slightly higher incidence of breast cancer (132) . Nonetheless other authors failed to detect significant differences for breast cancer risk between metformin users and non-users (133,134) These conflicting results may reflect differences in drug exposure , follow-up time and patient characteristics Retrospective clinical studies support the use of metformin as an anti-cancer treatment to improve survival rates in diabetic women with breast cancer ( 135,136) (Table 5). He et al …”

Section: Clinical Datamentioning

confidence: 99%

See 1 more Smart Citation

Metformin use and gynecological cancers: A novel treatment option emerging from drug repositioning

Gadducci

Biglia

Tana

et al. 2016

Critical Reviews in Oncology/Hematology

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Section: Discussionmentioning

confidence: 99%

Section: Clinical Datamentioning

confidence: 99%

Metformin use and gynecological cancers: A novel treatment option emerging from drug repositioning

Gadducci

Biglia

Tana

et al. 2016

Critical Reviews in Oncology/Hematology

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“…Limitations include availability of a small group of comorbidities and information on comorbidities (except previous cancer) based entirely on self-report. Better understanding of overall and breast-cancer specific mortality in relation to the individual comorbidities, as well as a combination of comorbidities such as the Charlson Comorbidity Index, diagnosed before as well as after (35–37) breast cancer diagnosis, will be needed. Our cancer registry information on radiation and chemotherapy for breast cancer was limited to the first course of treatment.…”

Section: Discussionmentioning

confidence: 99%

Diabetes and Other Comorbidities in Breast Cancer Survival by Race/Ethnicity: The California Breast Cancer Survivorship Consortium (CBCSC)

Kurian

Kwan

et al. 2015

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background The role of comorbidities in survival of breast cancer patients has not been well studied, particularly in non-white populations. Methods We investigated the association of specific comorbidities with mortality in a multiethnic cohort of 8,952 breast cancer cases within the California Breast Cancer Survivorship Consortium (CBCSC), which pooled questionnaire and cancer registry data from five California-based studies. In total, 2,187 deaths (1,122 from breast cancer) were observed through December 31, 2010. Using multivariable Cox proportional hazards regression, we estimated hazards ratios (HR) and 95% confidence intervals (CI) for overall and breast cancer-specific mortality associated with previous cancer, diabetes, high blood pressure (HBP), and myocardial infarction (MI). Results Risk of breast cancer-specific mortality increased among breast cancer cases with a history of diabetes (HR=1.48, 95% CI=1.18, 1.87) or MI (HR=1.94, 95% CI=1.27–2.97). Risk patterns were similar across race/ethnicity (non-Latina White, Latina, African American and Asian American), body size, menopausal status, and stage at diagnosis. In subgroup analyses, risk of breast cancer-specific mortality was significantly elevated among cases with diabetes who received neither radiation nor chemotherapy (HR=2.11, 95% CI=1.32–3.36); no increased risk was observed among those who received both treatments (HR=1.13, 95% CI= 0.70–1.84) (P interaction= 0.03). A similar pattern was found for MI by radiation and chemotherapy (P interaction=0.09). Conclusion These results may inform future treatment guidelines for breast cancer patients with a history of diabetes or MI. Impact Given the growing number of breast cancer survivors worldwide, we need to better understand how comorbidities may adversely affect treatment decisions and ultimately outcome.

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“…While our results were not statistically significant for DM, they suggest that DM but not impaired glucose tolerance may increase risk of recurrence and second primary BC. However, results from a retrospective cohort study of 3,124 women with stages I–III BC by Kiderlen et al [45] suggest a decreased risk of recurrence in women with diabetes compared to women without diabetes (HR=0.77, 95% CI 0.59–1.01), particularly in ages ≥75 years (HR=0.67, 95% CI 0.45–0.98). One possible explanation for results indicating no association or possibly an inverse relationship is that adverse influences of DM or impaired glucose tolerance on BC prognosis could be counterbalanced by potential protective effects of some DM medications, such as metformin [46].…”

Section: Discussionmentioning

confidence: 99%

Metabolic syndrome and outcomes following early-stage breast cancer

Calip

Malone

Gralow

et al. 2014

Breast Cancer Res Treat

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Purpose The prevalence of risk factors contributing to metabolic syndrome (MetS) is increasing, and numerous components of MetS are associated with increased primary breast cancer (BC) risk. However, less is known about the relationship of metabolic syndrome to BC outcomes. The aim of this study was to evaluate whether MetS, characterized by increased weight, hypertension, low HDL-cholesterol, high triglycerides and diabetes or impaired glucose tolerance, is associated with risk of second breast cancer events (SBCE) and BC-specific mortality. Methods Retrospective cohort study of women diagnosed with incident early stage (I–II) BC between 1990–2008, enrolled in an integrated health plan. Outcomes of interest were SBCE, defined as recurrence or second primary BC, and BC-specific mortality. We used multivariable Cox proportional hazards models to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CI) for time-varying exposure to MetS components while accounting for potential confounders and competing risks. Results Among 4,216 women in the cohort, 26% had ≥3 MetS components and 13% developed SBCE during median follow-up of 6.3 years. Compared to women with no MetS components, presence of MetS (≥3 components) was associated with increased risk of SBCE (HR=1.50, 95% CI 1.08–2.07) and BC-specific mortality (HR=1.65, 95% CI 1.02–2.69). Of the individual components, only increased weight was associated with increased risk of SBCE (HR=1.26, 95% CI 1.06–1.49). Conclusions MetS is associated with modestly increased risk of SBCE and BC-specific mortality. Given the growing population of BC survivors, further research in larger and more diverse populations is warranted.

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Diabetes in relation to breast cancer relapse and all-cause mortality in elderly breast cancer patients: a FOCUS study analysis

Cited by 45 publications

References 24 publications

Metformin use and gynecological cancers: A novel treatment option emerging from drug repositioning

Metformin use and gynecological cancers: A novel treatment option emerging from drug repositioning

Diabetes and Other Comorbidities in Breast Cancer Survival by Race/Ethnicity: The California Breast Cancer Survivorship Consortium (CBCSC)

Metabolic syndrome and outcomes following early-stage breast cancer

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