曾患妊娠糖尿病妇女的乳腺癌:一项基于全国登记的队列研究。

IF 7.4 1区 医学 Q1 Medicine Breast Cancer Research Pub Date : 2024-11-04 DOI:10.1186/s13058-024-01908-4
Maria Hornstrup Christensen, Christina Anne Vinter, Thomas Bastholm Olesen, Maria Houborg Petersen, Ellen Aagaard Nohr, Katrine Hass Rubin, Marianne Skovsager Andersen, Dorte Moeller Jensen
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引用次数: 0

摘要

背景:妊娠糖尿病(GDM)是一种常见的妊娠并发症,其特点是胰岛素抵抗。胰岛素抵抗与女性最常见的癌症--乳腺癌之间存在联系。因此,曾患 GDM 的妇女患乳腺癌的风险可能会增加,但现有的证据并不一致。本研究探讨了 GDM 与乳腺癌发病之间的关系,包括癌症确诊时的年龄。此外,我们还调查了妊娠期胰岛素抵抗的严重程度以及随后糖尿病的发展对乳腺癌风险的潜在影响:我们在全国范围内开展了一项以登记为基础的队列研究,研究对象包括 1997 年至 2018 年期间丹麦的所有产妇。我们根据 ICD-10 编码定义了 GDM 和乳腺癌。绝经前和绝经后乳腺癌根据结果时的年龄进行实用定义:在 708121 名女性中,3.4% 患有 GDM。中位随访期为 11.9 年(0-21.9 年)。曾患和未患过 GDM 的女性患乳腺癌的总体风险相当(调整后的危险比为 0.96 [95% CI 0.83-1.12])。绝经前和绝经后患乳腺癌的风险也没有差异;但是,曾患 GDM 的妇女确诊乳腺癌的年龄较小(42.6 岁对 43.5 岁,P 值为 0.01)。全因死亡率与 GDM 史相似。妊娠期胰岛素抵抗的严重程度和随后的糖尿病并不影响乳腺癌风险:这项基于人群的大型队列研究显示,经过近12年的中位随访,与未患过GDM的女性相比,曾患GDM的女性罹患乳腺癌的风险并不高。这与绝经状态无关。妊娠期胰岛素抵抗的严重程度和随后的糖尿病发展对乳腺癌风险没有影响。无论是否有 GDM 史,都应优先关注乳腺癌的预防、早期发现和治疗。
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Breast cancer in women with previous gestational diabetes: a nationwide register-based cohort study.

Background: Gestational diabetes mellitus (GDM) is a common pregnancy complication characterized by insulin resistance. A link has been suggested between insulin resistance and breast cancer, which is the most common cancer in women. Hence, women with previous GDM may be at increased risk of developing breast cancer, yet, the existing evidence is conflicting. This study explored the association between GDM and incident breast cancer, including age at cancer diagnosis. Additionally, we investigated the potential impact of severity of insulin resistance during pregnancy and of subsequent diabetes development on the breast cancer risk.

Methods: We conducted a nationwide, register-based cohort study including all women giving birth in Denmark from 1997 to 2018. We defined GDM and breast cancer based on ICD-10 codes. Premenopausal and postmenopausal breast cancer was pragmatically defined as age at outcome < 50 years and ≥ 50 years, respectively. A proxy for severity of insulin resistance during pregnancy was based on insulin treatment; subsequent diabetes was defined as presence of ICD-10 codes and/or antidiabetic medication after pregnancy. The statistical analyses included Cox regression, logistic regression and t-test.

Results: Of 708,121 women, 3.4% had GDM. The median follow-up period was 11.9 years (range 0-21.9). The overall breast cancer risk was comparable in women with and without previous GDM (adjusted hazard ratio 0.96 [95% CI 0.83-1.12]). Premenopausal and postmenopausal breast cancer risk also did not differ; however, women with previous GDM had a breast cancer diagnosis at younger age (42.6 vs. 43.5 years, p-value 0.01). All-cause mortality was similar regardless of GDM history. Severity of insulin resistance during pregnancy and subsequent diabetes did not affect breast cancer risk.

Conclusions: This large, population-based cohort study showed no higher risk of incident breast cancer in women with previous GDM compared to women without previous GDM after a median of almost 12 years of follow-up. This was evident irrespective of menopausal state. The breast cancer risk was not influenced by the severity of insulin resistance during pregnancy and by subsequent diabetes development. Regardless of GDM history, attention towards prevention, early detection and treatment of breast cancer should be prioritized.

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来源期刊
CiteScore
12.00
自引率
0.00%
发文量
76
审稿时长
12 weeks
期刊介绍: Breast Cancer Research, an international, peer-reviewed online journal, publishes original research, reviews, editorials, and reports. It features open-access research articles of exceptional interest across all areas of biology and medicine relevant to breast cancer. This includes normal mammary gland biology, with a special emphasis on the genetic, biochemical, and cellular basis of breast cancer. In addition to basic research, the journal covers preclinical, translational, and clinical studies with a biological basis, including Phase I and Phase II trials.
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