Diabetes, metformin, and breast cancer in postmenopausal women

Rowan T. Chlebowski, Anne McTiernan, Jean Wactawski-Wende, JoAnn E. Manson, Aaron K. Aragaki, Thomas Rohan, Eli Ipp, Virginia G. Kaklamani, Mara Vitolins, Robert Wallace, Marc Gunter, Lawrence S. Phillips, Howard Strickler, Karen Margolis, David M Euhus

Research output: Contribution to journalArticle

Abstract

Purpose: Emerging evidence suggests that metformin may reduce breast cancer incidence, but reports are mixed and few provide information on tumor characteristics. Therefore, we assessed associations among diabetes, metformin use, and breast cancer in postmenopausal women participating in Women's Health Initiative clinical trials. Patients and Methods: In all, 68,019 postmenopausal women, including 3,401 with diabetes at study entry, were observed over a mean of 11.8 years with 3,273 invasive breast cancers diagnosed. Diabetes incidence status was collected throughout follow-up, with medication information collected at baseline and years 1, 3, 6, and 9. Breast cancers were confirmed by review of central medical records and pathology reports. Cox proportional hazards regression, adjusted for breast cancer risk factors, compared breast cancer incidence in women with diabetes who were metformin users or nonusers with breast cancer incidence in women without diabetes. Results: Compared with that in women without diabetes, breast cancer incidence in women with diabetes differed by diabetes medication type (P = .04). Women with diabetes receiving medications other than metformin had a slightly higher incidence of breast cancer (hazard ratio [HR], 1.16; 95% CI, 0.93 to 1.45), and women with diabetes who were given metformin had lower breast cancer incidence (HR, 0.75; 95% CI, 0.57 to 0.99). The association was observed for cancers positive for both estrogen receptor and progesterone receptor and those that were negative for human epidermal growth factor receptor 2. Conclusion: Metformin use in postmenopausal women with diabetes was associated with lower incidence of invasive breast cancer. These results can inform future studies evaluating metformin use in breast cancer management and prevention.

Original languageEnglish (US)
Pages (from-to)2844-2852
Number of pages9
JournalJournal of Clinical Oncology
Volume30
Issue number23
DOIs
StatePublished - 2012
Externally publishedYes

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Metformin
Breast Neoplasms
Incidence
Women's Health
Progesterone Receptors
Estrogen Receptors
Medical Records
Neoplasms
Clinical Trials
Pathology

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Chlebowski, R. T., McTiernan, A., Wactawski-Wende, J., Manson, J. E., Aragaki, A. K., Rohan, T., ... Euhus, D. M. (2012). Diabetes, metformin, and breast cancer in postmenopausal women. Journal of Clinical Oncology, 30(23), 2844-2852. https://doi.org/10.1200/JCO.2011.39.7505

Diabetes, metformin, and breast cancer in postmenopausal women. / Chlebowski, Rowan T.; McTiernan, Anne; Wactawski-Wende, Jean; Manson, JoAnn E.; Aragaki, Aaron K.; Rohan, Thomas; Ipp, Eli; Kaklamani, Virginia G.; Vitolins, Mara; Wallace, Robert; Gunter, Marc; Phillips, Lawrence S.; Strickler, Howard; Margolis, Karen; Euhus, David M.

In: Journal of Clinical Oncology, Vol. 30, No. 23, 2012, p. 2844-2852.

Research output: Contribution to journalArticle

Chlebowski, RT, McTiernan, A, Wactawski-Wende, J, Manson, JE, Aragaki, AK, Rohan, T, Ipp, E, Kaklamani, VG, Vitolins, M, Wallace, R, Gunter, M, Phillips, LS, Strickler, H, Margolis, K & Euhus, DM 2012, 'Diabetes, metformin, and breast cancer in postmenopausal women', Journal of Clinical Oncology, vol. 30, no. 23, pp. 2844-2852. https://doi.org/10.1200/JCO.2011.39.7505
Chlebowski RT, McTiernan A, Wactawski-Wende J, Manson JE, Aragaki AK, Rohan T et al. Diabetes, metformin, and breast cancer in postmenopausal women. Journal of Clinical Oncology. 2012;30(23):2844-2852. https://doi.org/10.1200/JCO.2011.39.7505
Chlebowski, Rowan T. ; McTiernan, Anne ; Wactawski-Wende, Jean ; Manson, JoAnn E. ; Aragaki, Aaron K. ; Rohan, Thomas ; Ipp, Eli ; Kaklamani, Virginia G. ; Vitolins, Mara ; Wallace, Robert ; Gunter, Marc ; Phillips, Lawrence S. ; Strickler, Howard ; Margolis, Karen ; Euhus, David M. / Diabetes, metformin, and breast cancer in postmenopausal women. In: Journal of Clinical Oncology. 2012 ; Vol. 30, No. 23. pp. 2844-2852.
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abstract = "Purpose: Emerging evidence suggests that metformin may reduce breast cancer incidence, but reports are mixed and few provide information on tumor characteristics. Therefore, we assessed associations among diabetes, metformin use, and breast cancer in postmenopausal women participating in Women's Health Initiative clinical trials. Patients and Methods: In all, 68,019 postmenopausal women, including 3,401 with diabetes at study entry, were observed over a mean of 11.8 years with 3,273 invasive breast cancers diagnosed. Diabetes incidence status was collected throughout follow-up, with medication information collected at baseline and years 1, 3, 6, and 9. Breast cancers were confirmed by review of central medical records and pathology reports. Cox proportional hazards regression, adjusted for breast cancer risk factors, compared breast cancer incidence in women with diabetes who were metformin users or nonusers with breast cancer incidence in women without diabetes. Results: Compared with that in women without diabetes, breast cancer incidence in women with diabetes differed by diabetes medication type (P = .04). Women with diabetes receiving medications other than metformin had a slightly higher incidence of breast cancer (hazard ratio [HR], 1.16; 95{\%} CI, 0.93 to 1.45), and women with diabetes who were given metformin had lower breast cancer incidence (HR, 0.75; 95{\%} CI, 0.57 to 0.99). The association was observed for cancers positive for both estrogen receptor and progesterone receptor and those that were negative for human epidermal growth factor receptor 2. Conclusion: Metformin use in postmenopausal women with diabetes was associated with lower incidence of invasive breast cancer. These results can inform future studies evaluating metformin use in breast cancer management and prevention.",
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N2 - Purpose: Emerging evidence suggests that metformin may reduce breast cancer incidence, but reports are mixed and few provide information on tumor characteristics. Therefore, we assessed associations among diabetes, metformin use, and breast cancer in postmenopausal women participating in Women's Health Initiative clinical trials. Patients and Methods: In all, 68,019 postmenopausal women, including 3,401 with diabetes at study entry, were observed over a mean of 11.8 years with 3,273 invasive breast cancers diagnosed. Diabetes incidence status was collected throughout follow-up, with medication information collected at baseline and years 1, 3, 6, and 9. Breast cancers were confirmed by review of central medical records and pathology reports. Cox proportional hazards regression, adjusted for breast cancer risk factors, compared breast cancer incidence in women with diabetes who were metformin users or nonusers with breast cancer incidence in women without diabetes. Results: Compared with that in women without diabetes, breast cancer incidence in women with diabetes differed by diabetes medication type (P = .04). Women with diabetes receiving medications other than metformin had a slightly higher incidence of breast cancer (hazard ratio [HR], 1.16; 95% CI, 0.93 to 1.45), and women with diabetes who were given metformin had lower breast cancer incidence (HR, 0.75; 95% CI, 0.57 to 0.99). The association was observed for cancers positive for both estrogen receptor and progesterone receptor and those that were negative for human epidermal growth factor receptor 2. Conclusion: Metformin use in postmenopausal women with diabetes was associated with lower incidence of invasive breast cancer. These results can inform future studies evaluating metformin use in breast cancer management and prevention.

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