The Influence of Hormone Therapy on secondary diabetes mellitus in Breast Cancer: A Meta-analysis

Feng Ye; Jiahuai Wen; Anli Yang; Yan Wang; Na Li; Ping Yu; Weidong Wei; Jun Tang

doi:10.1016/j.clbc.2021.06.014

The Influence of Hormone Therapy on secondary diabetes mellitus in Breast Cancer: A Meta-analysis

Clin Breast Cancer. 2022 Jan;22(1):e48-e58. doi: 10.1016/j.clbc.2021.06.014. Epub 2021 Jul 21.

Authors

Feng Ye¹, Jiahuai Wen², Anli Yang¹, Yan Wang¹, Na Li¹, Ping Yu¹, Weidong Wei³, Jun Tang⁴

Affiliations

¹ Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.
² Department of Breast Oncology, Guangdong Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China.
³ Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China. Electronic address: weiwd@sysucc.org.cn.
⁴ Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China. Electronic address: tangjun@sysucc.org.cn.

PMID: 34429242
DOI: 10.1016/j.clbc.2021.06.014

Abstract

Background: Growing evidences have implied that patients with primary breast cancer (BC) were at increased risks of developing diabetes mellitus (DM). However, as a major adjuvant treatment, the influence of hormone therapy (HT) on secondary DM in primary BC remains controversial; we conducted a meta-analysis of existing studies to evaluate the association of hormone therapy and secondary DM.

Methods: We searched online databases (PubMed, EMBASE, the Cochrane library, Scopus, and Google Scholar) for studies exploring the influence of hormone therapy on secondary DM in BC. The summarized effect sizes (ES) and 95% confidence interval (95% CI) are calculated by STATA software utilizing fixed-effect or random-effect models, depending on the heterogeneity of the eligible studies.

Results: Ultimately, 7 retrospective publications including a total of 44,524 primary BC patients are eligible in present meta-analysis. HT use significantly increased the risk of developing DM in primary BC patients, whenever compared with NON-HT BC patients (pooled adjusted HR 1.30, 95% CI: 1.19-1.43) or NORMAL participants (HR 1.19, 95% CI: 1.14-1.25). As to specific HT medications, our sub-analysis demonstrates the risk for DM in tamoxifen (TAM) users elevates by 30% than NON-TAM use BC patients (pooled HR 1.30, 95% CI: 1.20-1.40) and by 18% than NORMAL participants (pooled HR 1.18, 95% CI: 1.12-1.24). However, for aromatase inhibitors (AIs) users, the risks for DM do not elevate significantly. Funnel plots and Egger's tests are used to evaluate publication bias and no apparent bias is detected in all analysis.

Conclusion: The present study is the first meta-analysis which thoroughly reveals that adjuvant HT is a risk factor of secondary DM in primary female BC patients. As to specific HT medications, TAM use significantly enhances the incidence of secondary DM, while AIs use does not influence the DM incidence significantly. Our results can help clinicians to tailor more appropriate strategies for the therapy and follow-up of primary BC patients.

Keywords: Breast cancer; Diabetes mellitus; Hormone therapy; Meta-analysis; Tamoxifen.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't

MeSH terms

Aromatase Inhibitors / adverse effects*
Breast Neoplasms / complications
Breast Neoplasms / drug therapy*
Diabetes Mellitus / diagnosis
Diabetes Mellitus / etiology*
Disease Susceptibility
Female
Humans
Retrospective Studies
Risk Factors

Substances

Aromatase Inhibitors