Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA.
Department of Breast Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Diabetes Metab Res Rev. 2024 Jan;40(1):e3709. doi: 10.1002/dmrr.3709. Epub 2023 Aug 7.
Diabetes mellitus (DM) has been proposed to be positively associated with breast cancer (BCa) risk due to shared risk factors, metabolic dysfunction, and the use of antidiabetic medications. We conducted a systematic review and meta-analysis to evaluate the association between DM and BCa risk. We searched PubMed, Embase, and Web of Science for cohort and case-control studies assessing the association between DM and BCa published before 10 December 2021. Two reviewers independently screened the studies for inclusion, abstracted article data, and rated study quality. Random effects models were used to estimate summary risk ratios (RRs) and 95% confidence intervals (CIs). From 8396 articles identified in the initial search, 70 independent studies were included in the meta-analysis. DM was associated with an overall increased risk of BCa (RR = 1.20, 95% CI: 1.11-1.29). The 24 case-control studies demonstrated a stronger association (RR = 1.26, 95% CI: 1.13-1.40) than the 46 cohort studies (RR = 1.15, 95% CI: 1.05-1.27). Studies reporting risk by menopausal status found that postmenopausal women had an elevated risk of developing BCa (RR = 1.12, 95% CI: 1.07-1.17). No association between DM and BCa risk was observed among premenopausal women (RR = 0.95, 95% CI: 0.85-1.05). In addition, DM was associated with significantly increased risks of oestrogen receptor (ER)+ (RR = 1.09, 95% CI: 1.00-1.20), ER- (RR = 1.16, 95% CI: 1.04-1.30), and triple negative BCa (RR = 1.41, 95% CI: 1.01-1.96). The association estimate for human epidermal growth factor 2-positive BCa was also positive (RR = 1.21, 95% CI: 0.52-2.82), but the CI was wide and crossed the null. Our meta-analysis confirms a modest positive association between DM and BCa risk. In addition, our results suggest that the association between DM and BCa may be modified by menopausal status, and that DM may be differentially associated with BCa subtypes defined by receptor status. Additional studies are warranted to investigate the mechanisms underlying these associations and any influence of DM on BCa receptor expression.
糖尿病（DM）与乳腺癌（BCa）风险呈正相关，这可能是由于两者存在共同的风险因素、代谢功能障碍以及使用抗糖尿病药物。我们进行了一项系统评价和荟萃分析，以评估 DM 与 BCa 风险之间的关联。我们在 PubMed、Embase 和 Web of Science 中检索了截至 2021 年 12 月 10 日评估 DM 与 BCa 之间关联的队列和病例对照研究。两位审查员独立筛选研究以进行纳入、提取文章数据并评估研究质量。使用随机效应模型来估计汇总风险比（RR）和 95%置信区间（CI）。在最初搜索中确定的 8396 篇文章中，有 70 项独立研究纳入荟萃分析。DM 与 BCa 总体风险增加相关（RR=1.20，95%CI：1.11-1.29）。24 项病例对照研究显示出更强的关联（RR=1.26，95%CI：1.13-1.40），而 46 项队列研究的关联较弱（RR=1.15，95%CI：1.05-1.27）。报告按绝经状态风险的研究发现，绝经后女性发生 BCa 的风险增加（RR=1.12，95%CI：1.07-1.17）。在绝经前女性中，DM 与 BCa 风险之间无关联（RR=0.95，95%CI：0.85-1.05）。此外，DM 与雌激素受体（ER）+（RR=1.09，95%CI：1.00-1.20）、ER-（RR=1.16，95%CI：1.04-1.30）和三阴性 BCa（RR=1.41，95%CI：1.01-1.96）的风险显著增加相关。人表皮生长因子 2 阳性 BCa 的关联估计也为阳性（RR=1.21，95%CI：0.52-2.82），但 CI 较宽并穿过零。我们的荟萃分析证实了 DM 与 BCa 风险之间存在适度的正相关。此外，我们的结果表明，DM 与 BCa 之间的关联可能受到绝经状态的修饰，并且 DM 可能与受体状态定义的 BCa 亚型存在差异相关。需要进一步研究来探讨这些关联的潜在机制以及 DM 对 BCa 受体表达的任何影响。
