Schairer Catherine, Gadalla Shahinaz M, Pfeiffer Ruth M, Moore Steven C, Engels Eric A
National Cancer Institute, Division of Cancer Epidemiology and Genetics, NIH, Bethesda, Maryland.
Cancer Epidemiol Biomarkers Prev. 2017 Jun;26(6):862-868. doi: 10.1158/1055-9965.EPI-16-0647. Epub 2017 Jan 13.
Obesity has been associated with substantially higher risk of inflammatory breast cancer (IBC) than other breast cancer. Here, we assess whether comorbidities of obesity, namely diabetes, abnormal glucose, dyslipidemia, and hypertension, are differentially related to risk of IBC and other breast cancers by tumor stage at diagnosis (localized/regional/distant/unstaged). We used linked SEER-Medicare data, with female breast cancer cases ages 66+ years identified by SEER registries (years 1992-2011). We divided first breast cancers into IBC ( = 2,306), locally advanced non-IBC (LABC; = 10,347), and other ( = 197,276). We selected female controls ( = 200,000) from a stratified 5% random sample of Medicare recipients alive and breast cancer free. We assessed exposures until 12 months before diagnosis/selection using Medicare claims data. We estimated odds ratios (OR) and 99.9% confidence intervals (CI) using unconditional logistic regression. Diabetes was associated with increased risk of distant IBC (98.5% of IBC cases; OR 1.44; 99.9% CI 1.21-1.71), distant (OR 1.24; 99.9% CI, 1.09-1.40) and regional (OR 1.29 (99.9% CI, 1.14-1.45) LABC, and distant (OR 1.23; 99.9% CI, 1.10-1.39) and unstaged (OR 1.32; 99.9% CI, 1.18-1.47) other breast cancers. Dyslipidemia was associated with reduced risk of IBC (OR 0.80; 95% CI, 0.67-0.94) and other breast cancers except localized disease. Results were similar by tumor estrogen receptor status. Abnormal glucose levels and hypertension had little association with risk of any tumor type. Associations with diabetes and dyslipidemia were similar for distant stage IBC and other advanced tumors. If confirmed, such findings could suggest avenues for prevention. .
肥胖与炎性乳腺癌(IBC)的风险显著高于其他乳腺癌。在此,我们评估肥胖的合并症,即糖尿病、血糖异常、血脂异常和高血压,在诊断时(局部/区域/远处/未分期)是否与IBC和其他乳腺癌的风险存在差异关联。我们使用了SEER - 医疗保险链接数据,通过SEER登记处(1992 - 2011年)确定年龄在66岁及以上的女性乳腺癌病例。我们将首次发生的乳腺癌分为IBC(n = 2306)、局部晚期非IBC(LABC;n = 10347)和其他(n = 197276)。我们从存活且无乳腺癌的医疗保险受益人的分层5%随机样本中选取女性对照(n = 200000)。我们使用医疗保险理赔数据评估诊断/选择前12个月的暴露情况。我们使用无条件逻辑回归估计比值比(OR)和99.9%置信区间(CI)。糖尿病与远处IBC风险增加相关(IBC病例的98.5%;OR 1.44;99.9% CI 1.21 - 1.71),远处(OR 1.24;99.9% CI,1.09 - 1.40)和区域(OR 1.29(99.9% CI,1.14 - 1.45)LABC,以及远处(OR 1.23;99.9% CI,1.10 - 1.39)和未分期(OR 1.32;99.9% CI,1.18 - 1.47)其他乳腺癌。血脂异常与IBC风险降低相关(OR 0.80;95% CI,0.67 - 0.94)以及除局部疾病外的其他乳腺癌。按肿瘤雌激素受体状态分析结果相似。血糖异常和高血压与任何肿瘤类型的风险关联不大。远处IBC和其他晚期肿瘤与糖尿病和血脂异常的关联相似。如果得到证实,这些发现可能为预防提供途径。