Epidemiology and outcomes of previously undiagnosed diabetes in older women with breast cancer: an observational cohort study based on SEER-MedicareReport as inadecuate




Epidemiology and outcomes of previously undiagnosed diabetes in older women with breast cancer: an observational cohort study based on SEER-Medicare - Download this document for free, or read online. Document in PDF available to download.

BMC Cancer

, 12:613

Epidemiology, prevention and public health

Abstract

BackgroundIn breast cancer, diabetes diagnosed prior to cancer previously diagnosed is associated with advanced cancer stage and increased mortality. However, in the general population, 40% of diabetes is undiagnosed until glucose testing, and evidence suggests one consequence of increased evaluation and management around breast cancer diagnosis is the increased detection of previously undiagnosed diabetes. Biological factors – for instance, higher insulin levels due to untreated disease - and others underlying the association between previously diagnosed diabetes and breast cancer could differ in those whose diabetes remains undiagnosed until cancer. Our objectives were to identify factors associated with previously undiagnosed diabetes in breast cancer, and to examine associations between previously undiagnosed diabetes and cancer stage, treatment patterns, and mortality.

MethodsUsing Surveillance, Epidemiology, and End Results-Medicare, we identified women diagnosed with breast cancer and diabetes between 01-2001 and 12-2005. Diabetes was classified as previously diagnosed if it was identified within Medicare claims between 24 and 4 months before cancer diagnosis, and previously undiagnosed if it was identified from 3 months before to ≤ 3 months after cancer. Patients were followed until 12-2007 or death, whichever came first. Multivariate analyses were performed to examine risk factors for previously undiagnosed diabetes and associations between undiagnosed compared to previously diagnosed diabetes, cancer stage, treatment, and mortality.

ResultsOf 2,418 patients, 634 26% had previously undiagnosed diabetes; the remainder had previously diagnosed diabetes. The mean age was 77.8 years, and 49.4% were diagnosed with in situ or stage I disease. Age > 80 years 40% of the cohort and limited health system contact primary care physician and-or preventive services prior to cancer were associated with higher adjusted odds of previously undiagnosed diabetes. Previously undiagnosed diabetes was associated with higher adjusted odds of advanced stage III-IV cancer Odds Ratio = 1.37: 95% Confidence Interval CI 1.05 – 1.80; P = 0.02, and a higher adjusted mortality rate due to causes other than cancer Hazard Ratio = 1.29; 95% CI 1.02 – 1.63; P = 0.03.

ConclusionsIn breast cancer, previously undiagnosed diabetes is associated with advanced stage cancer and increased mortality. Identifying biological factors would require further investigation.

KeywordsBreast cancer Diabetes Previously undiagnosed Risk factors Stage Mortality Survival Electronic supplementary materialThe online version of this article doi:10.1186-1471-2407-12-613 contains supplementary material, which is available to authorized users.

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Author: Robert I Griffiths - Mark D Danese - Michelle L Gleeson - José M Valderas

Source: https://link.springer.com/



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