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History of Gestational Diabetes Mellitus and Risk of Incident Invasive Breast Cancer among Parous Women in the Nurses' Health Study II Prospective Cohort.
Cancer Epidemiol Biomarkers Prev 2017; 26(3):321-327CE

Abstract

Background:

Type II diabetes is associated with breast cancer in epidemiologic studies. Pregnancy also modifies breast cancer risk. We hypothesized that women with a history of gestational diabetes mellitus (GDM), which shares pathogenesis and risk factors with type II diabetes, would have greater invasive breast cancer risk than parous women without a history of GDM.

Methods:

We conducted a prospective analysis among parous women in the Nurses' Health Study II, with mean age 35 years in 1989. Multivariate Cox proportional hazards models were used to compare risks of incident invasive breast cancer in women with and without a history of GDM.

Results:

Among 86,972 women studied, 5,188 women reported a history of GDM and 2,377 developed invasive breast cancer (100 with history of GDM, 2,277 without GDM) over 22 years of prospective follow-up. History of GDM was inversely associated with incident invasive breast cancer [HR, 0.68; 95% confidence interval (CI), 0.55-0.84; P = 0.0004], compared with no history of GDM, after adjustment for body mass index, reproductive history, and other breast cancer risk factors. Findings were similar by menopausal status, although observed person-time was predominantly premenopausal (premenopausal: HR, 0.73; 95% CI, 0.56-0.96; P = 0.03; postmenopausal: HR, 0.63; 95% CI, 0.43-0.92; P = 0.02). Restricting to women undergoing mammography screening modestly attenuated the relationship (HR, 0.74; 95% CI, 0.57-0.96; P = 0.02).

Conclusions:

Among a large cohort of U.S. women, history of GDM was not associated with an elevated risk of subsequent invasive breast cancer.Impact: Our findings highlight the need to further investigate GDM's role in breast cancer development. Cancer Epidemiol Biomarkers Prev; 26(3); 321-7. ©2016 AACR.

Authors+Show Affiliations

Diabetes Unit, Massachusetts General Hospital, Boston, Massachusetts.Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts. Department of Obstetrics, Gynecology and Reproductive Biology, Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital, Boston, Massachusetts. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts. Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts.Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts. Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, Massachusetts.Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts. Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts. Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Rockville, Maryland.Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts. Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, Massachusetts.Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts. krexrode@partners.org.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

27729356

Citation

Powe, Camille E., et al. "History of Gestational Diabetes Mellitus and Risk of Incident Invasive Breast Cancer Among Parous Women in the Nurses' Health Study II Prospective Cohort." Cancer Epidemiology, Biomarkers & Prevention : a Publication of the American Association for Cancer Research, Cosponsored By the American Society of Preventive Oncology, vol. 26, no. 3, 2017, pp. 321-327.
Powe CE, Tobias DK, Michels KB, et al. History of Gestational Diabetes Mellitus and Risk of Incident Invasive Breast Cancer among Parous Women in the Nurses' Health Study II Prospective Cohort. Cancer Epidemiol Biomarkers Prev. 2017;26(3):321-327.
Powe, C. E., Tobias, D. K., Michels, K. B., Chen, W. Y., Eliassen, A. H., Manson, J. E., ... Rexrode, K. M. (2017). History of Gestational Diabetes Mellitus and Risk of Incident Invasive Breast Cancer among Parous Women in the Nurses' Health Study II Prospective Cohort. Cancer Epidemiology, Biomarkers & Prevention : a Publication of the American Association for Cancer Research, Cosponsored By the American Society of Preventive Oncology, 26(3), pp. 321-327. doi:10.1158/1055-9965.EPI-16-0601.
Powe CE, et al. History of Gestational Diabetes Mellitus and Risk of Incident Invasive Breast Cancer Among Parous Women in the Nurses' Health Study II Prospective Cohort. Cancer Epidemiol Biomarkers Prev. 2017;26(3):321-327. PubMed PMID: 27729356.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - History of Gestational Diabetes Mellitus and Risk of Incident Invasive Breast Cancer among Parous Women in the Nurses' Health Study II Prospective Cohort. AU - Powe,Camille E, AU - Tobias,Deirdre K, AU - Michels,Karin B, AU - Chen,Wendy Y, AU - Eliassen,A Heather, AU - Manson,JoAnn E, AU - Rosner,Bernard, AU - Willett,Walter C, AU - Hu,Frank B, AU - Zhang,Cuilin, AU - Rich-Edwards,Janet W, AU - Rexrode,Kathryn M, Y1 - 2016/10/11/ PY - 2016/07/25/received PY - 2016/09/29/revised PY - 2016/09/29/accepted PY - 2016/10/13/pubmed PY - 2018/2/13/medline PY - 2016/10/13/entrez SP - 321 EP - 327 JF - Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology JO - Cancer Epidemiol. Biomarkers Prev. VL - 26 IS - 3 N2 - Background: Type II diabetes is associated with breast cancer in epidemiologic studies. Pregnancy also modifies breast cancer risk. We hypothesized that women with a history of gestational diabetes mellitus (GDM), which shares pathogenesis and risk factors with type II diabetes, would have greater invasive breast cancer risk than parous women without a history of GDM.Methods: We conducted a prospective analysis among parous women in the Nurses' Health Study II, with mean age 35 years in 1989. Multivariate Cox proportional hazards models were used to compare risks of incident invasive breast cancer in women with and without a history of GDM.Results: Among 86,972 women studied, 5,188 women reported a history of GDM and 2,377 developed invasive breast cancer (100 with history of GDM, 2,277 without GDM) over 22 years of prospective follow-up. History of GDM was inversely associated with incident invasive breast cancer [HR, 0.68; 95% confidence interval (CI), 0.55-0.84; P = 0.0004], compared with no history of GDM, after adjustment for body mass index, reproductive history, and other breast cancer risk factors. Findings were similar by menopausal status, although observed person-time was predominantly premenopausal (premenopausal: HR, 0.73; 95% CI, 0.56-0.96; P = 0.03; postmenopausal: HR, 0.63; 95% CI, 0.43-0.92; P = 0.02). Restricting to women undergoing mammography screening modestly attenuated the relationship (HR, 0.74; 95% CI, 0.57-0.96; P = 0.02).Conclusions: Among a large cohort of U.S. women, history of GDM was not associated with an elevated risk of subsequent invasive breast cancer.Impact: Our findings highlight the need to further investigate GDM's role in breast cancer development. Cancer Epidemiol Biomarkers Prev; 26(3); 321-7. ©2016 AACR. SN - 1538-7755 UR - https://www.unboundmedicine.com/medline/citation/27729356/History_of_Gestational_Diabetes_Mellitus_and_Risk_of_Incident_Invasive_Breast_Cancer_among_Parous_Women_in_the_Nurses'_Health_Study_II_Prospective_Cohort_ L2 - http://cebp.aacrjournals.org/cgi/pmidlookup?view=long&pmid=27729356 DB - PRIME DP - Unbound Medicine ER -