Lipscombe Lorraine L, Fischer Hadas D, Austin Peter C, Fu Longdi, Jaakkimainen R Liisa, Ginsburg Ophira, Rochon Paula A, Narod Steven, Paszat Lawrence
Women's College Research Institute, Women's College Hospital, 790 Bay St, Room 741, Toronto, ON, M5G 1N8, Canada,
Breast Cancer Res Treat. 2015 Apr;150(3):613-20. doi: 10.1007/s10549-015-3323-5. Epub 2015 Mar 17.
Women with diabetes have higher breast cancer incidence and mortality. The purpose of this study was to examine the impact of diabetes on stage at breast cancer diagnosis, as a possible reason for their higher mortality. Using population-based health databases from Ontario, Canada, this retrospective cohort study examined stage at diagnosis (II, III, or IV vs I) among women aged 20-105 years who were newly diagnosed with invasive breast cancer between 2007 and 2012. We compared those with diabetes to those without diabetes. Diabetes was defined based on medical records using a validated algorithm. Among 38,407 women with breast cancer, 6115 (15.9 %) women had diabetes. Breast cancer patients with diabetes were significantly more likely to present with advanced-stage breast cancer than those without diabetes. After adjustment for mammograms and other covariates, diabetes was associated with a significantly increased risk of Stage II [adjusted odds ratio (aOR) 1.14, 95 % confidence interval (CI) 1.07, 1.22], Stage III (aOR 1.21, 95 % CI 1.11, 1.33), and Stage IV (aOR 1.16, 95 % CI 1.01, 1.33) versus Stage I breast cancer. Women with diabetes had a higher risk of lymph node metastases (aOR 1.16, 95 % CI 1.06, 1.27) and tumors with size over 2 cm (aOR 1.16, 95 % CI 1.06, 1.28). Diabetes was associated with more advanced-stage breast cancer, even after accounting for differences in screening mammogram use and other factors. Our findings suggest that diabetes may predispose to more aggressive breast cancer, which may be a contributor to their higher cancer mortality.
患有糖尿病的女性患乳腺癌的发病率和死亡率更高。本研究的目的是探讨糖尿病对乳腺癌诊断分期的影响，这可能是其死亡率较高的一个原因。利用加拿大安大略省基于人群的健康数据库，这项回顾性队列研究调查了2007年至2012年间新诊断为浸润性乳腺癌的20至105岁女性的诊断分期（II、III或IV期与I期）。我们将患有糖尿病的女性与未患糖尿病的女性进行了比较。糖尿病是根据医疗记录使用经过验证的算法定义的。在38407名乳腺癌女性中，6115名（15.9%）女性患有糖尿病。患有糖尿病的乳腺癌患者比未患糖尿病的患者更有可能患晚期乳腺癌。在对乳房X光检查和其他协变量进行调整后，与I期乳腺癌相比，糖尿病与II期（调整后的优势比[aOR]1.14，95%置信区间[CI]1.07，1.22）、III期（aOR 1.21，95%CI 1.11，1.33）和IV期（aOR 1.16，95%CI 1.01，1.33）乳腺癌的风险显著增加相关。患有糖尿病的女性发生淋巴结转移的风险更高（aOR 1.16，95%CI 1.06，1.27），肿瘤大小超过2厘米的风险也更高（aOR 1.16，95%CI 1.06，1.28）。即使在考虑了乳房X光筛查使用差异和其他因素后，糖尿病仍与更晚期的乳腺癌相关。我们的研究结果表明，糖尿病可能易患侵袭性更强的乳腺癌，这可能是其癌症死亡率较高的一个原因。
