2012年12月14日讯 /生物谷BIOON/ --近日，一项新研究表明绝经后乳腺癌幸存者比未患乳腺癌者更容易患糖尿病。此外，乳腺癌和糖尿病之间之间的关系会有所不同，这取决于是否乳腺癌幸存者经历了化疗。相关研究结果发表在Diabetologia杂志上。
糖尿病和癌症之间有关联越来越被大家认可。例如，糖尿病妇女患乳腺癌风险高出约20％。由于乳腺癌患者生存率不断提高，了解幸存者的长期健康结果变得越来越重要。然而，迄今为止很少有研究分析了绝经后乳腺癌幸存者患糖尿病的风险。
在新研究中，Lorraine Lipscombe博士和同事使用1996年到2008年之间加拿大安大略省病例数据，比较年龄在55岁及以上的乳腺癌妇女糖尿病的发病率，并与年龄相匹配的未患乳腺癌妇女对比。
在24,976乳腺癌幸存者和124880名对照者中，在平均随访5.8年中9.7％的人罹患糖尿病。相比未患乳腺癌的妇女，乳腺癌幸存者的糖尿病风险在确诊两年后开始增加，10年后从7％上升到21％。但那些接受辅助化疗（4,404例）患者几乎存在相反关系，在诊断最初两年后（与对照组相比风险增加4％）患糖尿病风险是最高的，然后10年后风险的增加率下降到8％。
Lipscombe博士说：化疗治疗可能会导致易感妇女糖尿病发病更早。化疗结果导致雌激素抑制也可能促进糖尿病。其他因素如化疗妇女服用糖皮质激素类药物也可能发挥作用。
胰岛素抵抗诱发糖尿病和多种类型的癌症，起初胰岛素抵抗与高胰岛素水平相关，但有证据表明血循环中高胰岛素可能增加患癌症的风险。然而，糖尿病只发生在胰岛素水平开始下降的许多年后，因此，当胰岛素水平高时胰岛素抵抗个体发生癌症的风险可能要远远早于糖尿病。这些发现证实了需要更密切地监测乳腺癌幸存者的糖尿病。（生物谷Bioon.com）
doi:10.1007/s00125-012-2793-9
Incidence of diabetes among postmenopausal breast cancer survivors
L. L. Lipscombe, W. W. Chan, L. Yun, P. C. Austin, G. M. Anderson, P. A. Rochon
Aims/hypothesis
Evidence is emerging of an association between breast cancer and diabetes; however, it is uncertain whether diabetes incidence is increased in postmenopausal breast cancer survivors compared with women without breast cancer. The objective of this study was to determine whether postmenopausal women who develop breast cancer have a higher incidence of diabetes than those who do not develop breast cancer.
Methods
We used population-based data from Ontario, Canada to compare the incidence of diabetes among women with breast cancer, aged 55 years or older, from 1996 to 2008, with that of age-matched women without breast cancer. We used Cox proportional hazard models to estimate the effect of breast cancer on the cause-specific hazard of developing diabetes overall and in the subgroup of women who received adjuvant chemotherapy.
Results
Of 24,976 breast cancer survivors and 124,880 controls, 9.7% developed diabetes over a mean follow-up of 5.8 years. The risk of diabetes among breast cancer survivors compared with women without breast cancer began to increase 2 years after diagnosis (HR 1.07 [95% CI, 1.02, 1.12]), and rose to an HR of 1.21 (95% CI, 1.09, 1.35) after 10 years. Among those who received adjuvant chemotherapy (n?=?4,404), risk was highest in the first 2 years after diagnosis (HR 1.24 [95% CI 1.12, 1.38]) and then declined.
Conclusions/interpretation
We found a modest increase in the incidence of diabetes among postmenopausal breast cancer survivors that varied over time. In most women the risk began to increase 2 years after cancer diagnosis but the highest risk was in the first 2 years in those who received adjuvant therapy. Our study suggests that greater diabetes screening and prevention strategies among breast cancer survivors may be warranted.
