Among African-American women, those with type 2 diabetes (T2DM) may have a higher risk of developing estrogen receptor (ER)-negative breast cancer, according to results of a study published in Cancer Research, a journal of the American Asso?ciation for Cancer Research (AACR). The study was funded by the National Institutes of Health (NIH) and in part by the Dahod Breast Cancer Research Program at the Boston University School of Medicine. 
?Our results showed statistically significant evidence of an increased risk of ER-negative breast cancer in black women who had T2DM before they ever had breast cancer, primarily in the women who had diabetes for at least five years,? noted Julie R. Palmer, ScD, associate director of Boston University?s Slone Epidemiology Center, professor of epidemiology at Boston University School of Public Health, and associate director for population sciences at the BU-BMC Cancer Center. They did not find an association with ER-positive breast cancer in the same cohort.
…We’re still trying to understand the basic biological processes that lead to ER-negative breast cancer. …One way to do this is to study factors that are more common in an African-American population…
The majority of breast cancers are ER-positive. This type of breast cancer is the easiest to treat and has the highest survival rate. In contrast, African-American women are disproportionally affected by ER-negative breast cancers, with double the incidence as compared to white women.
?Our findings may account for some of the racial disparity in breast cancer, and could partly explain why mortality from breast cancer is so much higher in black women than white women,? Palmer explained.
?We are still trying to understand the basic biological processes that lead to ER-negative breast cancer. One way to do this is to study factors that are more common in an African-American population,? she added.
Several studies suggest that diabetes is a risk factor for breast cancer, and T2DM is twice as prevalent in African-American women as compared to white women, commented Palmer. One previous study analyzed the association with type 2 diabetes and breast cancer in African- American women, but did not report results separately for ER-negative and ER-positive breast cancer.
Black Women?s Health Study
The analyses conducted by Palmer and colleagues were based on information provided by participants in the Black Women?s Health Study (BWHS). The BWHS was established over 20 years ago and utilizes biennial questionnaires to obtain information from 59,000 African- American women from across the United States. Using this large data set, Palmer and colleagues could control for many factors, including age and body mass index (BMI).
The study showed a Hazard Ratio (HR) for T2DM relative to no T2DM of 1.18 [95% confidence interval (CI) 1.00?1.40] for overall breast cancer incidence, with the increase accounted for by ER? breast cancer: HRs were 1.02 (95% CI, 0.80?1.31) for ER+ and 1.43 (95% CI, 1.03?2.00) for ER? cancer. The HR for T2D and ER? breast cancer was highest among nonobese women (1.92; 95% CI, 1.22?3.04).
Abnormal metabolic status
Importantly, the association between T2DM and ER-negative breast cancer was observed only among women with lower BMI (<30). This suggests that abnormal metabolic status may play a larger role in ER-negative breast cancer than obesity, Palmer said.
Palmer stressed that further work is needed to corroborate these relatively new findings. ?If these results are confirmed, T2DM would be a modifiable risk factor for ER-negative breast cancer,? Palmer said.
?Women could reduce their chances of getting ER-negative breast cancer if they could avoid developing T2DM. Monitoring of blood sugar levels to identify pre-diabetes may allow for early interventions to prevent diabetes,? she added.
Palmer?s future work includes testing if diabetes medication, such as metformin, could lower the risk for ER-negative breast cancer.
Limitations of the study include a dependence on self-reports rather than medical records for classification of T2DM status. Additionally, due to the relatively small sample size in specific subgroups, there was a lack of statistical power for the analysis of medication use.
Last Editorial Review: November 15, 2017
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