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Risk of breast cancer in patients diagnosed with Type 2 diabetes (T2DM): an observational study using the UK General Practitioner Research Database (GPRD)
Thesis

Risk of breast cancer in patients diagnosed with Type 2 diabetes (T2DM): an observational study using the UK General Practitioner Research Database (GPRD)

Maryann Attah
Master of Public Health (M.P.H.), Drexel University
Jun 2012
DOI:
https://doi.org/10.17918/etd-3923
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Attah_Maryann_2012346.75 kB
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Abstract

Type 2 Diabetes Breast--Cancer Public Health
Background: Cancer and diabetes are common conditions that exert serious effect on public health in the United States. Their co-diagnosis in the same individual is not uncommon. Both conditions are seen to share risk factors such as obesity and sedentary lifestyle. Despite the extensive body of literature on the risk of cancer in individuals with diabetes, only a few have examined the pattern of cancer risk during different study time window following diabetes onset. To this end, there is a need to access the association between T2DM duration and the risk of breast cancer in order to accurately provide more effective interventions. Objective: To identify the risk of breast cancer associated with patients diagnosed with Type 2 diabetes mellitus (T2DM). An additional objective of this study is to examine the risk of breast cancer in individuals with incident type 2 diabetes during different time windows following T2DM onset. Also to evaluate any potential ascertainment or surveillance bias around the time of T2DM diagnosis compared to patients without diabetes. Methods: A retrospective cohort study was conducted on female participants (n= 2,318,205) utilizing the general practitioner research database (GPRD) to assess the incidence of breast cancer events in T2DM patients. The comparison group was patients without diabetes. The study period was 1 January 2003 to 31 December 2010. Results: A total of 118,174 patients with T2DM and 2,200,031 patients without diabetes were identified. Patients with T2DM were 2 times more likely to have breast cancer compared to patients without diabetes (1.792 [1.708, 1.880]). After adjustment for identified risk factors, age, BMI, alcohol, tobacco and estrogen use and Charlson Comorbidity Index (CCI), patients with T2DM were still at an increased risk (HR: 1.108 95% CI 1.053 -- 1.166). This association was still observed when cohort was categorized into a younger (<55) and an older age group (55+) in order to account for menopausal status. Examining breast cancer risk by duration of diabetes did not indicate a potential for detection bias. Conclusions: Women with T2DM may have a slightly increased risk of breast cancer and are seen to present with higher comorbid conditions. There was no suggestion of detection bias.

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