title: High fasting blood glucose and obesity significantly and independently increase risk of breast cancer death in hormone receptor-positive disease.
abstract: OBJECTIVE
  We investigated the effect of fasting blood glucose and body mass index (BMI) at diagnosis on risk of breast cancer death for cases diagnosed in five Italian cancer registries in 2003-2005 and followed up to the end of 2008.
  
  
  METHODS
  For 1607 Italian women (≥15 years) with information on BMI or blood glucose or diabetes, we analysed the risk of breast cancer death in relation to glucose tertiles (≤84.0, 84.1-94.0, >94.0 mg/dl) plus diabetic and unspecified categories; BMI tertiles (≤23.4, 23.5-27.3, >27.3 kg/m(2), unspecified), stage (T1-3N0M0, T1-3N+M0 plus T4anyNM0, M1, unspecified), oestrogen (ER) and progesterone (PR) status (ER+PR+, ER-PR-, ER and PR unspecified, other), age, chemotherapy and endocrine therapy, using multiple regression models. Separate models for ER+PR+ and ER-PR- cases were also run.
  
  
  RESULTS
  Patients often had T1-3N0M0, ER+PR+ cancers and received chemotherapy or endocrine therapy; only 6% were M1 and 17% ER-PR-. Diabetic patients were older and had more often high BMI (>27 kg/m(2)), ER-PR-, M1 cancers than other patients. For ER+PR+ cases, with adjustment for other variables, breast cancer mortality was higher in women with high BMI than those with BMI 23.5-27.3 kg/m(2) (hazard ratio (HR)=2.9, 95% confidence interval (CI) 1.2-6.9). Breast cancer mortality was also higher in women with high (>94 mg/dl) blood glucose compared to those with glucose 84.1-94.0mg/dl (HR=2.6, 95% CI 1.2-5.7).
  
  
  CONCLUSIONS
  Our results provide evidence that in ER+PR+ patients, high blood glucose and high BMI are independently associated with increased risk of breast cancer death. Detection and correction of these factors in such patients may improve prognosis.
authors.affiliation: Analytical Epidemiology and Health Impact Unit, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
authors.forename: Pamela
authors.initials: P
authors.lastname: Minicozzi
authors.forename: Franco
authors.initials: F
authors.lastname: Berrino
authors.forename: Federica
authors.initials: F
authors.lastname: Sebastiani
authors.forename: Fabio
authors.initials: F
authors.lastname: Falcini
authors.forename: Rosa
authors.initials: R
authors.lastname: Vattiato
authors.forename: Francesca
authors.initials: F
authors.lastname: Cioccoloni
authors.forename: Gioia
authors.initials: G
authors.lastname: Calagreti
authors.forename: Mario
authors.initials: M
authors.lastname: Fusco
authors.forename: Maria Francesca
authors.initials: MF
authors.lastname: Vitale
authors.forename: Rosario
authors.initials: R
authors.lastname: Tumino
authors.forename: Aurora
authors.initials: A
authors.lastname: Sigona
authors.forename: Mario
authors.initials: M
authors.lastname: Budroni
authors.forename: Rosaria
authors.initials: R
authors.lastname: Cesaraccio
authors.forename: Giuseppa
authors.initials: G
authors.lastname: Candela
authors.forename: Tiziana
authors.initials: T
authors.lastname: Scuderi
authors.forename: Maurizio
authors.initials: M
authors.lastname: Zarcone
authors.forename: Ildegarda
authors.initials: I
authors.lastname: Campisi
authors.forename: Milena
authors.initials: M
authors.lastname: Sant
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism*; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000150:complications / Q000378:metabolism / Q000401:mortality*; D048909:Diabetes Complications; D005215:Fasting / Q000097:blood*; D005260:Female; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications*; D011960:Receptors, Estrogen / Q000378:metabolism; D011980:Receptors, Progesterone / Q000378:metabolism; D012042:Registries / Q000706:statistics & numerical data; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone
keywords: Blood glucose; Breast cancer; Hormone receptor status; Obesity; Risk of death