title: Association between metformin therapy and mortality after breast cancer: a population-based study.
abstract: OBJECTIVE
  Metformin has been associated with a reduction in breast cancer risk and may improve survival after cancer through direct and indirect tumor-suppressing mechanisms. The purpose of this study was to evaluate the effect of metformin therapy on survival in women with breast cancer using methods that accounted for the duration of treatment with glucose-lowering therapies.
  
  
  METHODS
  This population-based study, using Ontario health care databases, recruited women aged 66 years or older diagnosed with diabetes and breast cancer between 1 April 1997 and 31 March 2008. Using Cox regression analyses, we explored the association between cumulative duration of past metformin use and all-cause and breast cancer-specific mortality. We modeled cumulative duration of past metformin use as a time-varying exposure.
  
  
  RESULTS
  Of 2,361 breast cancer patients identified, mean (±SD) age at cancer diagnosis was 77.4±6.3 years, and mean follow-up was 4.5±3.0 years. There were 1,101 deaths (46.6%), among which 386 (16.3%) were breast cancer-specific deaths. No significant association was found between cumulative duration of past metformin use and all-cause mortality (adjusted hazard ratio 0.97 [95% CI 0.92-1.02]) or breast cancer-specific mortality (0.91 [0.81-1.03]) per additional year of cumulative use.
  
  
  CONCLUSIONS
  Our findings failed to show an association between improved survival and increased cumulative metformin duration in older breast cancer patients who had recent-onset diabetes. Further research is needed to clarify this association, accounting for effects of cancer stage and BMI in younger populations or those with differing stages of diabetes as well as in nondiabetic populations.
authors: Corresponding author: Iliana C. Lega, iliana.lega@wchospital.ca.
authors: Iliana C
authors: IC
authors: Lega
authors: Peter C
authors: PC
authors: Austin
authors: Andrea
authors: A
authors: Gruneir
authors: Pamela J
authors: PJ
authors: Goodwin
authors: Paula A
authors: PA
authors: Rochon
authors: Lorraine L
authors: LL
authors: Lipscombe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000401:mortality*; D003920:Diabetes Mellitus / Q000188:drug therapy; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008687:Metformin / Q000627:therapeutic use*; D008875:Middle Aged
chemical_list: D007004:Hypoglycemic Agents; D008687:Metformin
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