2012年12月14日訊 /生物谷BIOON/ --近日,，一項(xiàng)新研究表明絕經(jīng)后乳腺癌幸存者比未患乳腺癌者更容易患糖尿病。此外,，乳腺癌和糖尿病之間之間的關(guān)系會(huì)有所不同,，這取決于是否乳腺癌幸存者經(jīng)歷了化療。相關(guān)研究結(jié)果發(fā)表在Diabetologia雜志上,。
糖尿病和癌癥之間有關(guān)聯(lián)越來(lái)越被大家認(rèn)可,。例如，糖尿病婦女患乳腺癌風(fēng)險(xiǎn)高出約20％,。由于乳腺癌患者生存率不斷提高,，了解幸存者的長(zhǎng)期健康結(jié)果變得越來(lái)越重要。然而,，迄今為止很少有研究分析了絕經(jīng)后乳腺癌幸存者患糖尿病的風(fēng)險(xiǎn),。
在新研究中，Lorraine Lipscombe博士和同事使用1996年到2008年之間加拿大安大略省病例數(shù)據(jù),，比較年齡在55歲及以上的乳腺癌婦女糖尿病的發(fā)病率,，并與年齡相匹配的未患乳腺癌婦女對(duì)比。
在24,976乳腺癌幸存者和124880名對(duì)照者中,，在平均隨訪5.8年中9.7％的人罹患糖尿病,。相比未患乳腺癌的婦女,，乳腺癌幸存者的糖尿病風(fēng)險(xiǎn)在確診兩年后開(kāi)始增加，10年后從7％上升到21％,。但那些接受輔助化療（4,404例）患者幾乎存在相反關(guān)系,，在診斷最初兩年后（與對(duì)照組相比風(fēng)險(xiǎn)增加4％）患糖尿病風(fēng)險(xiǎn)是最高的，然后10年后風(fēng)險(xiǎn)的增加率下降到8％,。
Lipscombe博士說(shuō)：化療治療可能會(huì)導(dǎo)致易感婦女糖尿病發(fā)病更早,。化療結(jié)果導(dǎo)致雌激素抑制也可能促進(jìn)糖尿病,。其他因素如化療婦女服用糖皮質(zhì)激素類藥物也可能發(fā)揮作用,。
胰島素抵抗誘發(fā)糖尿病和多種類型的癌癥，起初胰島素抵抗與高胰島素水平相關(guān),，但有證據(jù)表明血循環(huán)中高胰島素可能增加患癌癥的風(fēng)險(xiǎn),。然而，糖尿病只發(fā)生在胰島素水平開(kāi)始下降的許多年后,，因此,，當(dāng)胰島素水平高時(shí)胰島素抵抗個(gè)體發(fā)生癌癥的風(fēng)險(xiǎn)可能要遠(yuǎn)遠(yuǎn)早于糖尿病。這些發(fā)現(xiàn)證實(shí)了需要更密切地監(jiān)測(cè)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.
