Abstract
ABSTRACT Background Clinical experience and previous studies suggest that women with diabetes and breast cancer have worse outcomes than their non-diabetic counterparts. The purpose of this study was to examine the impact of diabetes and hyperglycemia on cancer-specific survival of patients with metastatic or recurrent breast cancer. Methods We performed a retrospective analysis of patients with advanced breast cancer receiving palliative chemotherapy from 2006 to 2011 at the National Cancer Institute in Mexico, and compared breast cancer-specific mortality in diabetic and non-diabetic patients, as well as in patients that presented hyperglycemia during palliative treatment. Results A total of 265 patients receiving palliative therapy were eligible for inclusion. Previous diagnosis or detection of diabetes at recurrence was recorded in 40 patients (15%). No difference was observed between diabetic and non-diabetic patients in terms of OS. A statistically significant difference in OS was observed between patients without diabetes and diabetic patients who had hyperglycemia (p = 0.003). OS in diabetic patients with proper metabolic control was shown to be superior compared to diabetics with hyperglycemia (p = 0.01) Hyperglycemia was identified in 14% of non-diabetics at some point while receiving palliative treatment. For patients that experienced hyperglycemia during treatment or who had a mean glucose level above 130, either in the diabetic or non-diabetic subgroups, a worse outcome was noted compared to normoglycemic patients, with a HR of 1.5 (p = 0.029) and HR of 2.04 (p = 0.006) for death, respectively. Conclusions Elevated glucose levels confer a poor outcome in diabetic and non-diabetic patients in contrast with patients with normoglycemic levels, conferring an elevated risk of death. According to these results, clinicians must monitor glucose levels during treatment for advanced breast cancer disease, and should take action in order to maintain normal glucose levels. Disclosure All authors have declared no conflicts of interest.
Highlights
Mexico, with a population greater than 100 million, currently has 10 million people with diabetes [1]
We examined the impact of diabetes and hyperglycemia on cancer-specific survival of patients with metastatic or recurrent breast cancer (BC)
Despite the growing body of evidence indicating that diabetes predicts a poor prognosis after a diagnosis of breast cancer, whether a threshold of glycemic status at which the risk for a poor prognosis significantly increases remains unknown
Summary
With a population greater than 100 million, currently has 10 million people with diabetes (types 1 and 2) [1]. Of this group, approximately 2 million are not aware of their condition, and 100,000 people will die from diabetes by the end of this year. Since 2006, breast cancer has been the leading cause of cancer mortality in Mexican women, accounting for 7.6% of female cancer-related deaths [2]. GLOBOCAN predictions for 2030 estimate that 24,386 women will be diagnosed with breast cancer in Mexico and that 9,778 (40.1%) will die from this disease [3]. Diabetes mellitus and breast cancer are major causes of morbidity and death in Mexico and on a global scale
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