Diabetes mellitus and breast cancer outcomes: a systematic review and meta-analysis.
OBJECTIVE
The goal of this study was to perform a systematic review and meta-analysis to examine the effect of pre-existing diabetes on breast cancer-related outcomes.


METHODS
We searched EMBASE and MEDLINE databases from inception through July 1, 2009, using search terms related to diabetes mellitus, cancer, and prognostic outcome. Studies were included if they reported a prognostic outcome by diabetes status, evaluated a cancer population, and contained original data published in the English language. We performed a meta-analysis of pre-existing diabetes and its effect on all-cause mortality in patients with breast cancer and qualitatively summarized other prognostic outcomes.


RESULTS
Of 8,828 titles identified, eight articles met inclusion/exclusion criteria and described outcomes in patients with breast cancer and diabetes. Pre-existing diabetes was significantly associated with all-cause mortality in six of seven studies. In a meta-analysis, patients with breast cancer and diabetes had a significantly higher all-cause mortality risk (pooled hazard ratio [HR], 1.49; 95% CI, 1.35 to 1.65) compared with their nondiabetic counterparts. Three of four studies found pre-existing diabetes to be associated with more advanced stage at presentation. Diabetes was also associated with altered regimens for breast cancer treatment and increased toxicity from chemotherapy.


CONCLUSIONS
Compared with their nondiabetic counterparts, patients with breast cancer and pre-existing diabetes have a greater risk of death and tend to present at later stages and receive altered treatment regimens. Studies are needed to investigate pathophysiologic interactions between diabetes and breast cancer and determine whether improvements in diabetes care can reduce mortality in patients with breast cancer.
Division of General Internal Medicine, Johns Hopkins University School of Medicine, 10753 Falls Rd, Suite 325, Lutherville, MD 21093, USA. kpeairs@jhmi.edu
Kimberly S
KS
Peairs
Bethany B
BB
Barone
Claire F
CF
Snyder
Hsin-Chieh
HC
Yeh
Kelly B
KB
Stein
Rachel L
RL
Derr
Frederick L
FL
Brancati
Antonio C
AC
Wolff
D001943:Breast Neoplasms / Q000188:drug therapy* / Q000453:epidemiology* / Q000378:metabolism / Q000473:pathology; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000453:epidemiology* / Q000378:metabolism; D005260:Female; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology*; D009367:Neoplasm Staging; D011379:Prognosis; D012307:Risk Factors