Association of the severity of diabetes-related complications with stage of breast cancer at diagnosis among elderly women with pre-existing diabetes

• Published in: Breast cancer research and treatment 2018-01, Vol.167 (1), p.183-193
• Main Authors: Alenzi, Ebtihag O., Madhavan, S. Suresh, Tan, Xi
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Analysis; Breast cancer; Breast Neoplasms - complications; Breast Neoplasms - diagnosis; Breast Neoplasms - epidemiology; Breast Neoplasms - pathology; Cancer diagnosis; Cancer prevention; Cancer research; Cancer screening; Complications and side effects; Diabetes; Diabetes Complications - epidemiology; Diabetes Complications - pathology; Diabetes mellitus; Diabetics; Diagnosis; Early Detection of Cancer; Elderly; Epidemiology; Female; Geriatrics; Humans; Mammography; Mass Screening; Medical screening; Medicare; Medicine; Medicine & Public Health; Neoplasm Staging; Older people; Oncology; SEER Program; Severity of Illness Index; United States
• ISSN: 0167-6806; 1573-7217
• DOI: 10.1007/s10549-017-4477-0

Purpose This study assessed the association between the severity of diabetes complications using diabetes complications severity index (DCSI) and stage of breast cancer (BC) at diagnosis among elderly women with pre-existing diabetes and incident BC. Methods Using Surveillance, Epidemiology and End Results-Medicare data, we identified women with incident BC during 2004–2011 and pre-existing diabetes ( N  = 7729). Chi-square tests were used to test for group differences in stage of BC at diagnosis. Multinomial logistic regression was used to examine the associations between the severity of diabetes complications and stage of BC at diagnosis. Results Overall, women with a DCSI = 2 and a DCSI ≥ 3 were more likely to be diagnosed at advanced stages as compared to those with no diabetes complications. In full adjusted association (after adding BC screening to the analysis model), the severity of diabetes complications was no longer an independent predictor of advanced stages at diagnosis. However, women with a DCSI = 2 were 26% more likely to be diagnosed at stage I (versus stage 0) of BC at diagnosis as compared to those without diabetes complications (OR 1.26, 95% CI 1.03–1.53). Conclusion The increased likelihood of having advanced-stage BC at diagnosis associated with severity of diabetes-related complications appears to be mediated by lower rates of breast cancer screening among elderly women with pre-existing diabetes complications. Therefore, reducing disparity in receiving breast cancer screening among elderly women with diabetes may reduce the risk of advanced-stage breast cancer diagnosis.