Abstract
ObjectiveWe investigated the overall and age-specific risks of developing breast and endometrial cancer among women with diabetes in a population-based cohort study.MethodsWomen with diabetes (n = 319310) and age-matched controls (n = 319308), selected from ambulatory care claims and beneficiary registry in 2000, respectively were linked to the in-patient claims (2000–2008) to identify admissions due to breast (ICD-9-CM: 174) and endometrial (ICD-9-CM: 182) cancer. The person-year approach with Poisson assumption was used to estimate the incidence density rate. The age-specific hazard ratios (HRs) of above malignancies in relation to diabetes with multivariate Cox proportional hazard regression.ResultsThe overall incidence density rate of breast and endometrial cancer was estimated at 1.21 and 0.21 per 10,000 patient-years, respectively, for diabetes. The corresponding figures for controls were lower at 1.00 and 0.14 per 10,000 patient-years. Compared with the controls, the covariate adjusted HR for breast and endometrial cancer was 1.42 (95% confidence interval (CI) 1.34–1.50) and 1.71 (95% CI 1.48–1.97), respectively in women with diabetes. Elderly (> = 65 years) diabetes had the highest HR (1.61) of breast cancer, while the highest HR (1.85) of endometrial cancer was observed in diabetes aged < = 50 years.ConclusionsDiabetes may significantly increase the risks of breast and endometrial cancer in all age stratifications. Health education for strict adherence of cancer screening program in women with diabetes is essential.
Highlights
Apart from various microvascular and macrovascular complications, accompanying insulin resistance and hyperinsulinemia of diabetes have been hypothesized to be associated with many kinds of tumor, but links with breast and endometrial cancer remain controversial
Diabetes and breast cancer association was found to be more apparent among postmenopausal women [1,3,6,8,20], but a lack of statistically significant association between diabetes and premenopausal breast cancer could be due to limited number of breast cancer patients of younger ages
Because only 3 studies were conducted in Asian populations, whether geographical distribution can affect the relationship between diabetes and breast cancer remains speculative and unproven
Summary
Apart from various microvascular and macrovascular complications, accompanying insulin resistance and hyperinsulinemia of diabetes have been hypothesized to be associated with many kinds of tumor, but links with breast and endometrial cancer remain controversial. A number of studies found that women with diabetes were at increased risk of breast [1,2,3,4,5,6,7,8] and endometrial [1,2,7,9,10,11,12,13,14] cancer, but not all studies revealed similar association [15,16,17,18]. Recent literature review tends to support a link between diabetes and increased risk of breast [19] and endometrial [14] cancer in women, several questions remain open for investigations. Because only 3 studies were conducted in Asian populations, whether geographical distribution can affect the relationship between diabetes and breast cancer remains speculative and unproven
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