1
|
Christ JP, Yu O, Barton B, Schulze-Rath R, Grafton J, Cronkite D, Covey J, Kelley A, Holden E, Hilpert J, Sacher F, Micks E, Reed SD. Risk Factors for Incident Polycystic Ovary Syndrome Diagnosis. J Womens Health (Larchmt) 2024. [PMID: 38557154 DOI: 10.1089/jwh.2023.0741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Objective: While highly prevalent, risk factors for incident polycystic ovary syndrome (PCOS) are poorly delineated. Using a population-based cohort, we sought to identify predictors of incident PCOS diagnosis. Materials and Methods: A matched case-control analysis was completed utilizing patients enrolled in Kaiser Permanente Washington from 2006 to 2019. Inclusion criteria included female sex, age 16-40 years, and ≥3 years of prior enrollment with ≥1 health care encounter. PCOS cases were identified using International Classification of Diseases codes. For each incident case (n = 2,491), 5 patients without PCOS (n = 12,455) were matched based on birth year and enrollment status. Potential risk factors preceding diagnosis included family history of PCOS, premature menarche, parity, race, weight gain, obesity, valproate use, metabolic syndrome, epilepsy, prediabetes, and types 1 and 2 diabetes. Potential risk factors for incident PCOS diagnosis were assessed with univariate and multivariable conditional logistic regressions. Results: Mean age of PCOS cases was 26.9 years (SD 6.8). PCOS cases, compared with non-PCOS, were more frequently nulliparous (70.9% versus 62.4%) and in the 3 years prior to index date were more likely to have obesity (53.8% versus 20.7%), metabolic syndrome (14.5% versus 4.3%), prediabetes (7.4% versus 1.6%), and type 2 diabetes (4.1% versus 1.7%) (p < 0.001 for all comparisons). In multivariable models, factors associated with higher risk for incident PCOS included the following: obesity (compared with nonobese) Class I-II (body-mass index [BMI], 30-40 kg/m2; odds ratio [OR], 3.8; 95% confidence interval [CI], 3.4-4.2), Class III (BMI > 40 kg/m2; OR, 7.5, 95% CI, 6.5-8.7), weight gain (compared with weight loss or maintenance) of 1-10% (OR, 1.7, 95% CI, 1.3-2.1), 10-20% (OR, 1.9; 95% CI, 1.5-2.4), and >20% (OR, 2.6; 95% CI, 1.9-3.6), prediabetes (OR, 2.7; 95% CI, 2.1-3.4), and metabolic syndrome (OR, 1.8: 95% CI, 1.5-2.1). Conclusion: Excess weight gain, obesity, and metabolic dysfunction may play a key role in the ensuing phenotypic expression of PCOS. Treatment and prevention strategies targeted at preventing weight gain in early reproductive years may help reduce the risk of this syndrome.
Collapse
Affiliation(s)
- Jacob P Christ
- Department of Obstetrics and Gynecology, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Onchee Yu
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Brooke Barton
- School of Medicine, University of Washington, Seattle, Washington, USA
| | | | - Jane Grafton
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - David Cronkite
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Jennifer Covey
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Ann Kelley
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Erika Holden
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Jan Hilpert
- Translational Clinical Medicine, Bayer AG, Berlin, Germany
| | | | - Elizabeth Micks
- Department of Obstetrics and Gynecology, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Susan D Reed
- Department of Obstetrics and Gynecology, School of Medicine, University of Washington, Seattle, Washington, USA
| |
Collapse
|
2
|
Elshanbary AA, Zaazouee MS, Nourelden AZ, Al-Kafarna M, Matar SG, Elsaeidy AS, Ragab KM, Elhady MM, Albadrani GM, Altyar AE, Kensara OA, Abdel-Daim MM. Risk factors of diabetes and cancer-specific mortalities in patients with infiltrating ductal carcinoma of the breast: a population-based study. Eur J Cancer Prev 2023:00008469-990000000-00121. [PMID: 38190207 DOI: 10.1097/cej.0000000000000869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
BACKGROUND AND AIMS Breast cancer is considered one of the most common neoplasms worldwide. Diabetes (DM) increases mortality among postmenopausal patients with breast cancer. Our study aims to identify the risk factors of DM-specific mortality and infiltrating ductal carcinoma (IDC) mortality in patients with IDC of the breast. MATERIALS AND METHODS Data of IDC patients were obtained from the Surveillance, Epidemiology, and End Results database from 1975 to 2016. Independent variables included age, race, marital status, the primary site of IDC, breast subtype, the disease stage, grade, chemotherapy, radiation, and surgery. Kaplan-Meier, Cox and Binary regression tests were used to analyze the data using SPSS software. RESULTS A total of 673 533 IDC patients were analyzed. Of them, 4224 died due to DM and 116 822 died due to IDC. Factors that increase the risk of overall, IDC-specific, and DM-specific mortalities include older age, black race, widowed, uninsured, regional and distant stages, grade II and III, and no treatment with chemotherapy or radiotherapy or surgery. Additionally, the IDC mortality increased with separated status, all primary sites, all breast subtypes, and stage IV. CONCLUSION In patients with IDC, controlling DM besides cancer is recommended to reduce the mortality risk. Old, black, widowed, uninsured, regional and distant stages, grade II and III, and no treatment are common risk factors for DM- and IDC-mortality.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Ghadeer M Albadrani
- Department of Biology, College of Science, Princess Nourah bint Abdulrahman University, Riyadh
| | - Ahmed E Altyar
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University
- Pharmacy Program, Batterjee Medical College, Jeddah
| | - Osama A Kensara
- Department of Clinical Nutrition, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah
| | - Mohamed M Abdel-Daim
- Department of Pharmaceutical Sciences, Pharmacy Program, Batterjee Medical College, Jeddah, Saudi Arabia
- Pharmacology Department, Faculty of Veterinary Medicine, Suez Canal University, Ismailia, Egypt
| |
Collapse
|
3
|
Kallamadi PR, Esari D, Addi UR, Kesavan R, Putcha UK, Nagini S, Reddy GB. Obesity Associated with Prediabetes Increases the Risk of Breast Cancer Development and Progression-A Study on an Obese Rat Model with Impaired Glucose Tolerance. Int J Mol Sci 2023; 24:11441. [PMID: 37511200 PMCID: PMC10380482 DOI: 10.3390/ijms241411441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/24/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023] Open
Abstract
Patients with comorbidities of obesity and diabetes are recognized to be at high risk of breast cancer development and face worse breast cancer outcomes. Though several reports showed the reinforced link between obesity, diabetes, and prediabetes with breast cancer, the underlying molecular mechanisms are still unknown. The present study aimed to investigate the underlying molecular link between increased risks of breast cancer due to coincident diabetes or obesity using a spontaneous obese rat model with impaired glucose tolerance (WNIN/GR-Ob rat). A single dose of solubilized DMBA suspension (40 mg/kg body weight) was orally administered to the animals at the age of 60 days to induce breast tumors. The tumor incidence, latency period, tumor frequency, and tumor volume were measured. Histology, immunohistochemistry, and immunoblotting were performed to evaluate the tumor morphology and expression levels of signal molecules. The development of mammary tumors in GR-Ob rats was characterized by early onset and shorter latency periods compared to control lean rats. While 62% of obese rats developed breast tumors, tumor development in lean rats was only 21%. Overexpression of ER, PR, Ki67, and p53 markers was observed in tumor tissues of obese rats in comparison with lean rats. The levels of the hallmarks of cell proliferation and angiogenesis involved in IGF-1/PI3K/Akt/GSK3β/β-catenin signaling pathway molecules were upregulated in obese rat breast tumors compared to lean rats. Furthermore, obesity with prediabetes is associated with changes in IGF-1 signaling and acts on PI3K/Akt/GSK3β/β-catenin signaling, which results in rapid cell proliferation and development of breast tumors in obese rats than the lean rats. These results indicate that tumor onset and development were faster in spontaneous obese rat models with impaired glucose tolerance than in their lean counterparts.
Collapse
Affiliation(s)
| | - Deepshika Esari
- ICMR-National Institute of Nutrition, Hyderabad 500007, India
| | | | - Rushendhiran Kesavan
- UT Southwestern Medical Center, Children Research Institute, Dallas, TX 75390, USA
| | | | - Siddavaram Nagini
- Department of Biochemistry and Biotechnology, Annamalai University, Annamalinagar 608002, India
| | | |
Collapse
|
4
|
Gurney J, Stanley J, Teng A, Krebs J, Koea J, Lao C, Lawrenson R, Meredith I, Sika-Paotonu D, Sarfati D. Cancer and diabetes co-occurrence: A national study with 44 million person-years of follow-up. PLoS One 2022; 17:e0276913. [PMID: 36441693 PMCID: PMC9704677 DOI: 10.1371/journal.pone.0276913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/17/2022] [Indexed: 11/30/2022] Open
Abstract
The number of new cases of cancer is increasing each year, and rates of diabetes mellitus are also increasing dramatically over time. It is not an unusual occurrence for an individual to have both cancer and diabetes at the same time, given they are both individually common, and that one condition can increase the risk of the other. In this manuscript, we use national-level diabetes (Virtual Diabetes Register) and cancer (New Zealand Cancer Registry) data on nearly five million individuals over 44 million person-years of follow-up to examine the occurrence of cancer amongst a national prevalent cohort of patients with diabetes. We completed this analysis separately by cancer for the 24 most commonly diagnosed cancers in Aotearoa New Zealand, and then compared the occurrence of cancer among those with diabetes to those without diabetes. We found that the rate of cancer was highest amongst those with diabetes for 21 of the 24 most common cancers diagnosed over our study period, with excess risk among those with diabetes ranging between 11% (non-Hodgkin's lymphoma) and 236% (liver cancer). The cancers with the greatest difference in incidence between those with diabetes and those without diabetes tended to be within the endocrine or gastrointestinal system, and/or had a strong relationship with obesity. However, in an absolute sense, due to the volume of breast, colorectal and lung cancers, prevention of the more modest excess cancer risk among those with diabetes (16%, 22% and 48%, respectively) would lead to a substantial overall reduction in the total burden of cancer in the population. Our findings reinforce the fact that diabetes prevention activities are also cancer prevention activities, and must therefore be prioritised and resourced in tandem.
Collapse
Affiliation(s)
- Jason Gurney
- Cancer and Chronic Conditions (C3) Research Group, Department of Public Health, University of Otago, Wellington, New Zealand
- * E-mail:
| | - James Stanley
- Cancer and Chronic Conditions (C3) Research Group, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Andrea Teng
- Cancer and Chronic Conditions (C3) Research Group, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Jeremy Krebs
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Jonathan Koea
- Department of General Surgery, Waitemata District Health Board, Auckland, New Zealand
| | - Chunhuan Lao
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Ross Lawrenson
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Ineke Meredith
- Department of Surgery, Capital and Coast District Health Board, Wellington, New Zealand
| | - Dianne Sika-Paotonu
- Department of Pathology & Molecular Medicine, University of Otago, Wellington, New Zealand
| | - Diana Sarfati
- Te Aho o Te Kahu–Cancer Control Agency, Wellington, New Zealand
| |
Collapse
|
5
|
Gisinger T, Kautzky-Willer A, Leutner M. Need for improving immunization status and preventive care in diabetes mellitus patients. Wien Klin Wochenschr 2022. [PMID: 36138236 DOI: 10.1007/s00508-022-02080-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 08/04/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND The incidence and the comorbidities, such as infectious diseases (e.g. pneumonia or influenza) of diabetes mellitus are increasing. Therefore, the purpose of this study is to investigate immunization status and preventive care in diabetes mellitus patients. METHODS Two groups from the Austrian health interview survey 2014 were identified, a cohort of diabetes mellitus (DM) individuals (n = 678) and a non-diabetes mellitus (non-DM) cohort (n = 15,093). The frequencies of doctors' visits, preventive care and immunization status were compared. Furthermore, the study population was divided by age (> 50 years, < 50 years) and differences between > 50 years old DM with < 50 years old DM and the > 50 years old DM and > 50 years old Non-DM cohort were investigated. RESULTS In the DM cohort a higher frequency of influenza immunization (13.3% vs. 7.1%, p < 0.001), doctor visits (89.4% vs. 75.4%, p < 0.001), and preventive care, such as colonoscopy (11.2% vs. 6.8%, p < 0.001) and hemoccult tests (32.6% vs. 22.1%, p < 0.001) was observed. Even though older DM individuals have a higher risk for complications, the > 50 years DM cohort has similar frequencies of colonoscopy, hemoccult test and immunization against influenza and TBE (tick-borne encephalitis) compared to > 50 years Non-DM. Although the > 50 years old DM cohort had a higher frequency of doctors' visits, they still had lower frequencies of mammography and dentists' visits compared to > 50 years old Non-DM. In comparison to the < 50 years old DM cohort, the > 50 years DM cohort was related to lower intact immunization status of tetanus, diphtheria, Polio and TBE. Still a higher frequency of intact immunization of pneumococcus, influenza and doctors' visits in the > 50 years old DM cohort compared to the < 50 years old DM cohort can be reported. CONCLUSION Preventive care and immunization status in the DM cohort just differ slightly from the general cohort but still should be improved.
Collapse
|
6
|
Boakye D, Günther K, Niedermaier T, Haug U, Ahrens W, Nagrani R. Associations between comorbidities and advanced stage diagnosis of lung, breast, colorectal, and prostate cancer: A systematic review and meta-analysis. Cancer Epidemiol 2021; 75:102054. [PMID: 34773768 DOI: 10.1016/j.canep.2021.102054] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/30/2021] [Accepted: 10/20/2021] [Indexed: 12/20/2022]
Abstract
Comorbidities and advanced stage diagnosis (ASD) are both associated with poorer cancer outcomes, but the association between comorbidities and ASD is poorly understood. We summarized epidemiological evidence on the association between comorbidities and ASD of selected cancers in a systematic review and meta-analysis. We searched PubMed and Web of Science databases up to June 3rd, 2021 for studies assessing the association between comorbidities and ASD of lung, breast, colorectal, or prostate cancer. Summary odds ratios (ORs) and 95% confidence intervals (95%CIs) were calculated using random-effects models. Also, potential variations in the associations between comorbidities and ASD by cancer type were investigated using random-effects meta-regression. Thirty-seven studies were included in this review, including 8,069,397 lung, breast, colorectal, and prostate cancer patients overall. The Charlson comorbidity index score was positively associated with ASD (stages III-IV) of breast cancer but was inversely associated with ASD of lung cancer (pinteraction = 0.004). Regarding specific comorbidities, diabetes was positively associated with ASD (OR = 1.17, 95%CI = 1.09-1.26), whereas myocardial infarction was inversely associated with ASD (OR = 0.84, 95%CI = 0.75-0.95). The association between renal disease and ASD differed by cancer type (pinteraction < 0.001). A positive association was found with prostate cancer (OR = 2.02, 95%CI = 1.58-2.59) and an inverse association with colorectal cancer (OR = 0.84, 95%CI = 0.70-1.00). In summary, certain comorbidities (e.g., diabetes) may be positively associated with ASD of several cancer types. It needs to be clarified whether closer monitoring for early cancer signs or screening in these patients is reasonable, considering the problem of over-diagnosis particularly relevant in patients with short remaining life expectancy such as those with comorbidities. Also, evaluation of the cost-benefit relationship of cancer screening according to the type and severity of comorbidity (rather than summary scores) may be beneficial for personalized cancer screening in populations with chronic diseases.
Collapse
Affiliation(s)
- Daniel Boakye
- Department of Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.
| | - Kathrin Günther
- Department of Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Tobias Niedermaier
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ulrike Haug
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany; Faculty of Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Wolfgang Ahrens
- Department of Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany; Institute of Statistics, Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany
| | - Rajini Nagrani
- Department of Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| |
Collapse
|
7
|
Bae JM. History of Diabetes Mellitus and Risk of Breast Cancer in Asian Women: A Meta-Epidemiological Analysis of Population-Based Cohort Studies. J Menopausal Med 2020; 26:29-33. [PMID: 32307948 PMCID: PMC7160588 DOI: 10.6118/jmm.19014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/11/2020] [Accepted: 03/25/2020] [Indexed: 12/29/2022] Open
Abstract
Objectives Previous quantitative systematic reviews conducting subgroup analyses by race have reported that the association between diabetes and breast cancer in Asian women was inconclusive. The aim of this meta-epidemiological study (MES) was to evaluate this association from additional population-based cohort studies. Methods The potential subjects of this MES were six Asian cohort studies selected by previous systematic reviews. Additional reports were found from the selected articles using citation discovery tools. The study with the longest follow-up period was selected among prospective studies of the same cohorts. A summary relative risk (sRR) and its 95% confidence intervals (CI) were calculated using random effect models. Results Four cohort studies on Asian women were finally selected. The participants were from the women population of Korea, Japan, China, and Taiwan and included a total of 1,448,254 women. The sRR (95% CI) (I-squared value) was 1.20 (0.98–1.46) (63.1%). Conclusions This MES found that the history of diabetes mellitus was not associated with the risk of breast cancer in Asian women. As breast cancer in this population develops at a younger age, additional cohort studies are necessary to conduct a subgroup analysis by menopausal status at diagnosis of breast cancer in Asian women.
Collapse
Affiliation(s)
- Jong Myon Bae
- Department of Preventive Medicine, Jeju National University College of Medicine, Jeju, Korea.
| |
Collapse
|