Worse breast cancer prognosis in insulin treated diabetic patients - A population based registry study in Sweden

Research output: Contribution to journalPublished meeting abstract


Background. Diabetes may be linked to incidence of different tumor diseases and prognosis through various mechanisms such as the disease itself, hyperglycemia, obesity and anti-diabetes therapy. Material and methods. The study includes all women with BC diagnosed in Sweden between 2000 through 2008 (n=54406). The women had no previous cancer diagnosis during the period of 1958-1999. Dates of birth, BC diagnosis and TNM-stage where directly extracted from the cancer registry. The women's anti-diabetes therapy was gathered from the Swedish Prescribed Drug Registry. Information regarding the cause of death and date of death was obtained from the Cause of Death Registry and tbe Swedish Population Register up until the 31st of December 2012 and 31st of December 2013 respectively. Analyses have been restricted to patients receiving insulin therapy (n=2463) and their breast cancer prognosis has been calculated in comparison with breast cancer patients without diabetes. All analyses were adjusted for TNM-stage and age at diagnosis. Results. Patients with insulin treated diabetes had a worse prognosis compared with other women with breast cancer (HR 1.7, 95%CI 1.5-2.0). The worse prognosis could be seen both for patients with ER+ and ER- tumors. The worst prognosis was seen for patients treated with NPH insulins (HR 2.8, 95% CI 2.4-3.3) while patients treated with long-acting insulin analogs had an intermediate prognosis (HR 1.6, 95% CI 1.2-2.2). Those women treated with NPH insulins and metformin had a slightly worse prognosis (HR 1.4, 95% CI 1.0-1.8). The results for breast cancer specific survival and total survival were similar. Conclusion. Our results imply that insulin treated breast cancer patients have a worse survival compared with other women with breast cancer regardless of tumor stage. Metformin therapy may partially counteract the association.


Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cancer and Oncology


  • insulin, insulin derivative, metformin, isophane insulin, long acting insulin, breast cancer, cancer prognosis, human, register, diabetic patient, population, Sweden, prognosis, female, diabetes mellitus, patient, therapy, neoplasm, cancer staging, cancer patient, survival, cause of death, diagnosis, obesity, cancer specific survival, hyperglycemia, insulin treatment, death, cancer registry, cancer diagnosis, diseases
Original languageEnglish
Article numberAbstract P4-11-02
JournalCancer Research
Issue number9 Suppl
Publication statusPublished - 2015
Publication categoryResearch
Event37th San Antonio Breast Cancer Symposium - San Antonio, Texas, United States
Duration: 2014 Dec 92014 Dec 13