Abstract
Simple SummaryFemale breast cancer continues to be the leading cause of cancer deaths worldwide, and type 2 diabetes mellitus (T2DM) is one of the contributors to the poor prognosis of breast cancer. This raises the issue that T2DM might be associated with aggressive clinicopathological characteristics, which indicate pivotal prognostic values. This study aimed to clarify the differences in breast cancer characteristics at diagnosis between patients with and without pre-existing T2DM. Our meta-analyses showed an increased risk of being diagnosed with a late-stage tumor, large tumor size, and invasive lymph nodes in patients with T2DM. No significant results were observed for grade, estrogen/progesterone receptor, and human epidermal growth factor receptor. These findings indicate an association between T2DM and advanced breast cancer at diagnosis, and suggest that the more active role of breast cancer screening should be further explored for women with T2DM.Poor prognosis caused by type 2 diabetes mellitus (T2DM) in women with breast cancer is conferred, while the association between T2DM and breast tumor aggressiveness is still a matter of debate. This study aimed to clarify the differences in breast cancer characteristics, including stage, size, lymph node status, grade, estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor (Her2), between patients with and without pre-existing T2DM. PubMed, Embase, and Web of Science were searched for studies from 1 January 2010 to 2 July 2021. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were pooled by using a random effects model. T2DM was significantly associated with tumor stages III/IV versus cancers in situ and stages I/II (pooled ORs (pOR), 95% CI: 1.19; 1.04–1.36, p = 0.012), tumor size >20 versus ≤20 mm (pOR, 95% CI: 1.18; 1.04–1.35, p = 0.013), and lymph node invasion versus no involvement (pOR, 95% CI: 1.26; 1.05–1.51, p = 0.013). These findings suggest that women with T2DM are at a higher risk of late-stage tumors, large tumor sizes, and invasive lymph nodes at breast cancer diagnosis.
Highlights
IntroductionFemale breast cancer has overtaken lung cancer as the most commonly diagnosed cancer, with a total of 2.26 million cases in the year 2020 [2]
Global breast cancer incidence has been increasing during the last three decades [1].Female breast cancer has overtaken lung cancer as the most commonly diagnosed cancer, with a total of 2.26 million cases in the year 2020 [2]
In the previous review with a literature search from the inception to July 2009 [29], four studies were available on the association between diabetes and tumor stage, but only crude estimates were accessible; we updated the evidence from 1 January 2010 to
Summary
Female breast cancer has overtaken lung cancer as the most commonly diagnosed cancer, with a total of 2.26 million cases in the year 2020 [2]. Despite the steadily decreasing mortality rate of breast cancer in high-resource countries [3], breast cancer remains as the leading cause of cancer deaths and disability-adjusted-life-years for women worldwide [4]. It is estimated that more than one million women will die of breast cancer in the year 2040 [5]. Tumor stage at diagnosis is one of the key characteristics that defines breast cancer prognosis. Histologic grade, determined by morphologic features, can accurately predict tumor behavior, in earlier small tumors [10]. The molecular features, namely hormone receptors (i.e., estrogen receptor (ER) and progesterone receptor (PR))
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