Is gestational diabetes related to breast cancer: a case-control study

Document Type : Original Article

Authors

1 M.Sc. student of Midwifery, Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

2 Instructor, Department of Midwifery, Midwifery and Reproductive Health Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

3 Associate Professor, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

4 Assistant Professor, Department of Radiotherapy and Oncology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

5 Assistant Professor, Department of Biostatics, School of Paramedicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Abstract

Introduction: The most common cancer known worldwide that causes widespread mortality of women is breast cancer. One of the less known risk factors in women is hyperinsulinemia. Since identifying the risk factors help primary prevention and early detection of breast cancer, this study was performed aimed to determine the relationship between gestational diabetes and breast cancer in women referred to the hospitals of Tehran Shahid Beheshti University of Medical Sciences.
Methods: This comparative study was conducted on 450 women (n=150 in case group, n=300 in control group) referring to the hospitals of Tehran Shahid Beheshti University of Medical Sciences. Case group consisted of women with breast cancer based on pathologic record and physician diagnosis that at least one year has passed from their disease and control group were women without breast cancer who referred to other clinics in the same centers. Women were collected through interview and completing the questionnaire. Data were analyzed by SPSS software (version 24) and Independent t-test, Chi-square, chance ratio and logistic regression. P<0.05 was considered statistically significant.
Results: In case group, 30 (20%) and control group 17 (5.7%) had history of gestational diabetes. There was significant relationship between breast cancer and gestational diabetes (OR=3.64, CI= 95%, P<0.001,1.78-7.43), body mass index(OR=1.11,CI= 95%, P<0.001, 1.04-1.18) and age (OR=1.13, CI= 95%, P<0.001, 1.09-1.16). In women with a history of gestational diabetes, the risk of breast cancer was 3.64 times higher than the other of women (P<0.05).
Conclusion: Gestational diabetes can be regarded as a risk factor for breast cancer. It is suggested that gestational diabetes be used as an early indicator in the detection of breast cancer.

Keywords


  1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians 2021; 71(3):209-49.
  2. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin 2020; 70(1):7-30.
  3. Mahdavifar N, Ghoncheh M, Pakzad R, Momenimovahed Z, Salehiniya H. Epidemiology, incidence and mortality of bladder cancer and their relationship with the development index in the world. Asian Pacific Journal of Cancer Prevention 2016; 17(1):381-6.
  4. Hilakivi-Clarke L, De Assis S, Warri A. Exposures to synthetic estrogens at different times during the life, and their effect on breast cancer risk. Journal of mammary gland biology and neoplasia 2013; 18(1):25-42.
  5. Xue F, Michels KB. Diabetes, metabolic syndrome, and breast cancer: a review of the current evidence. The American journal of clinical nutrition 2007; 86(3):823S-35S.
  6. Samavat H, Kurzer MS. Estrogen metabolism and breast cancer. Cancer letters 2015; 356(2):231-43.
  7. Cunningham FG, Leveno KJ, Bloom SL, Dashe JS, Hoffman BL, Casey BM, et al. Williams Obstetrics. 25nd New York: McGraw-Hill Education; 2018.
  8. Jafari-Shobeiri M, Ghojazadeh M, Azami-Aghdash S, Naghavi-Behzad M, Piri R, Pourali-Akbar Y, et al. Prevalence and risk factors of gestational diabetes in Iran: a systematic review and meta-analysis. Iranian journal of public health 2015; 44(8):1036.
  9. Sella T, Chodick G, Barchana M, Heymann AD, Porath A, Kokia E, et al. Gestational diabetes and risk of incident primary cancer: a large historical cohort study in Israel. Cancer Causes & Control 2011; 22(11):1513-20.
  10. Perrin MC, Terry MB, Kleinhaus K, Deutsch L, Yanetz R, Tiram E, et al. Gestational diabetes and the risk of breast cancer among women in the Jerusalem Perinatal Study. Breast cancer research and treatment 2008; 108(1):129-35.
  11. Dawson SI. Long‐term risk of malignant neoplasm associated with gestational glucose intolerance. Cancer: Interdisciplinary International Journal of the American Cancer Society 2004; 100(1):149-55.
  12. Fuchs O, Sheiner E, Meirovitz M, Davidson E, Sergienko R, Kessous R. The association between a history of gestational diabetes mellitus and future risk for female malignancies. Archives of gynecology and obstetrics 2017; 295(3):731-6.
  13. Powe CE, Tobias DK, Michels KB, Chen WY, Eliassen AH, Manson JE, et al. History of gestational diabetes mellitus and risk of incident invasive breast cancer among parous women in the Nurses' Health Study II prospective cohort. Cancer Epidemiology and Prevention Biomarkers 2017; 26(3):321-7.
  14. Tong GX, Cheng J, Chai J, Geng QQ, Chen PL, Shen XR, et al. Association between gestational diabetes mellitus and subsequent risk of cancer: a systematic review of epidemiological studies. Asian Pacific Journal of Cancer Prevention 2014; 15(10):4265-9.
  15. Park YM, O'Brien KM, Zhao S, Weinberg CR, Baird DD, Sandler DP. Gestational diabetes mellitus may be associated with increased risk of breast cancer. British journal of cancer 2017; 116(7):960-3.
  16. Luo J, Hendryx M, Virnig B, Wen S, Chlebowski R, Chen C, et al. Pre-existing diabetes and breast cancer prognosis among elderly women. British journal of cancer 2015; 113(5):827-32.
  17. Bejaimal SA, Wu CF, Lowe J, Feig DS, Shah BR, Lipscombe LL. Short‐term risk of cancer among women with previous gestational diabetes: a population‐based study. Diabetic Medicine 2016; 33(1):39-46.
  18. Badakhsh M, Daneshi F, Abavisani M, Rafiemanesh H, Bouya S, Sheyback M, et al. Prevalence of gestational diabetes mellitus in Eastern Mediterranean region: a systematic review and meta-analysis. Endocrine 2019; 65(3):505-14.
  19. Weroha SJ, Haluska P. The insulin-like growth factor system in cancer. Endocrinology and Metabolism Clinics 2012; 41(2):335-50.
  20. Nagarajan A, Malvi P, Wajapeyee N. Oncogene-directed alterations in cancer cell metabolism. Trends in cancer 2016; 2(7):365-77.
  21. Wolf M, Sauk J, Shah A, Smirnakis KV, Jimenez-Kimble R, Ecker JL, et al. Inflammation and glucose intolerance: a prospective study of gestational diabetes mellitus Diabetes Care 2004; 27.
  22. Vounzoulaki E, Khunti K, Abner SC, Tan BK, Davies MJ, Gillies CL. Progression to type 2 diabetes in women with a known history of gestational diabetes: systematic review and meta-analysis. Bmj 2020; 369.
  23. Wojciechowska J, Krajewski W, Bolanowski M, Kręcicki T, Zatoński T. Diabetes and cancer: a review of current knowledge. Experimental and Clinical Endocrinology & Diabetes 2016; 124(05):263-75.
  24. Boyle P, Boniol M, Koechlin A, Robertson C, Valentini F, Coppens K, et al. Diabetes and breast cancer risk: a meta-analysis. British journal of cancer 2012; 107(9):1608-17.
  25. Liao S, Li J, Wei W, Wang L, Zhang Y, Li J, et al. Association between diabetes mellitus and breast cancer risk: a meta-analysis of the literature. Asian Pac J Cancer Prev 2011; 12(4):1061-5.
  26. Larsson SC, Mantzoros CS, Wolk A. Diabetes mellitus and risk of breast cancer: a meta‐ International journal of cancer 2007; 121(4):856-62.
  27. Yeganeh Z, Sheikhan Z, Kariman N, Hajian P, Nasiri M, Mirzadeh N. Relationship between pregnancy-associated variables and breast cancer risk: a systematic review. Iran J Obstet Gynecol Infertil 2018; 21(2):85-97.
  28. Chatterjee S, Khunti K, Davies MJ. Type 2 diabetes. The lancet 2017; 389(10085):2239-51.
  29. Chandrasekaran K, Swaminathan K, Chatterjee S, Dey A. Apoptosis in HepG2 cells exposed to high glucose. Toxicology in Vitro 2010; 24(2):387-96.
  30. Al-Azzawi F, Palacios S. Hormonal changes during menopause. Maturitas 2009; 63(2):135-7.
  31. Booth A, Magnuson A, Fouts J, Foster M. Adipose tissue, obesity and adipokines: role in cancer promotion. Hormone molecular biology and clinical investigation 2015; 21(1):57-74.
  32. Crujeiras AB, Diaz-Lagares A, Stefansson OA, Macias-Gonzalez M, Sandoval J, Cueva J, et al. Obesity and menopause modify the epigenomic profile of breast cancer. Endocr Relat Cancer 2017; 24(7):351-63.
  33. Hardefeldt PJ, Edirimanne S, Eslick GD. Diabetes increases the risk of breast cancer: a meta-analysis. Endocrine related Cancer 2012; 19(6):793.
  34. Maskarinec G, Fontaine A, Torfadottir JE, Lipscombe LL, Lega IC, Figueroa J, et al. The relation of type 2 diabetes and breast cancer incidence in Asian, Hispanic and African American Populations—a review. Canadian journal of diabetes 2018; 42(1):100-5.
  35. Anderson KN, Schwab RB, Martinez ME. Reproductive risk factors and breast cancer subtypes: a review of the literature. Breast cancer research and treatment 2014; 144(1):1-10.
  36. Youn HJ, Han W. A review of the epidemiology of breast cancer in Asia: focus on risk factors. Asian Pacific journal of cancer prevention: APJCP 2020; 21(4):867.