García-Esquinas Esther, Guinó Elisabeth, Castaño-Vinyals Gemma, Pérez-Gómez Beatriz, Llorca Javier, Altzibar Jone M, Peiró-Pérez Rosana, Martín Vicente, Moreno-Iribas Concepción, Tardón Adonina, Caballero Francisco Javier, Puig-Vives Montse, Guevara Marcela, Villa Tania Fernández, Salas Dolores, Amiano Pilar, Dierssen-Sotos Trinidad, Pastor-Barriuso Roberto, Sala María, Kogevinas Manolis, Aragonés Nuria, Moreno Víctor, Pollán Marina
Environmental and Cancer Epidemiology Unit, National Centre for Epidemiology, Carlos III Institute of Health (Instituto de Salud Carlos III-ISCIII), Avda. Monforte de Lemos, 5, 28029, Madrid, Spain.
Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
Acta Diabetol. 2016 Feb;53(1):99-107. doi: 10.1007/s00592-015-0756-6. Epub 2015 Apr 29.
The aim of this study was to evaluate the association of diabetes and diabetes treatment with risk of postmenopausal breast cancer.
Histologically confirmed incident cases of postmenopausal breast (N = 916) cancer were recruited from 23 Spanish public hospitals. Population-based controls (N = 1094) were randomly selected from primary care center lists within the catchment areas of the participant hospitals. ORs (95 % CI) were estimated using mixed-effects logistic regression models, using the recruitment center as a random effect term. Breast tumors were classified into hormone receptor positive (ER+ or PR+), HER2+ and triple negative (TN).
Diabetes was not associated with the overall risk of breast cancer (OR 1.09; 95 % CI 0.82-1.45), and it was only linked to the risk of developing TN tumors: Among 91 women with TN tumors, 18.7 % were diabetic, while the corresponding figure among controls was 9.9 % (OR 2.25; 95 % CI 1.22-4.15). Regarding treatment, results showed that insulin use was more prevalent among diabetic cases (2.5 %) as compared to diabetic controls (0.7 %); OR 2.98; 95 % CI 1.26-7.01. They also showed that, among diabetics, the risk of developing HR+/HER2- tumors decreased with longer metformin use (ORper year 0.89; 95 % CI 0.81-0.99; based on 24 cases and 43 controls).
This study reinforces the need to correctly classify breast cancers when studying their association with diabetes. Given the low survival rates in women diagnosed with TN breast tumors and the potential impact of diabetes control on breast cancer prevention, more studies are needed to better characterize this association.
本研究旨在评估糖尿病及其治疗与绝经后乳腺癌风险之间的关联。
从23家西班牙公立医院招募经组织学确诊的绝经后乳腺癌新发病例（N = 916）。基于人群的对照（N = 1094）从参与医院服务区域内的基层医疗中心名单中随机选取。使用混合效应逻辑回归模型估计比值比（OR）（95%置信区间），将招募中心作为随机效应项。乳腺肿瘤分为激素受体阳性（ER +或PR +）、HER2 +和三阴性（TN）。
糖尿病与乳腺癌总体风险无关（OR 1.09；95%置信区间0.82 - 1.45），仅与发生TN肿瘤的风险相关：在91例TN肿瘤患者中，18.7%患有糖尿病，而对照组中相应比例为9.9%（OR 2.25；95%置信区间1.22 - 4.15）。关于治疗，结果显示糖尿病患者中胰岛素使用比糖尿病对照组更普遍（2.5%对0.7%）；OR 2.98；95%置信区间1.26 - 7.01。结果还显示，在糖尿病患者中，二甲双胍使用时间越长，发生HR + /HER2 - 肿瘤的风险越低（每年OR 0.89；95%置信区间0.81 - 0.99；基于24例病例和43例对照）。
本研究强调在研究乳腺癌与糖尿病的关联时正确分类乳腺癌的必要性。鉴于TN乳腺肿瘤女性的低生存率以及糖尿病控制对乳腺癌预防的潜在影响，需要更多研究来更好地描述这种关联。
