Abstract
OBJECTIVE: Type 2 diabetes mellitus (T2DM) and cancer are prevalent conditions, with evidence linking T2DM to higher breast cancer incidence and mortality. However, it is uncertain whether excess mortality in breast cancer patients with diabetes is driven by cancer-related factors. This study aims to investigate overall survival (OS) and chemotherapy receipt post-surgery in women with diabetes and localised breast cancer. METHODS: Cohorts were constructed from electronic patient records on TriNetX, a de-identified patient database. Three cohorts included women with diabetes stratified by localised breast cancer stage (1 & 2, 3 and all), compared to control groups without diabetes. Cohorts were propensity score matched for age, ethnicity, smoking status and BMI. OS and chemotherapy receipt were compared. RESULTS: Patients with diabetes (n = 1,488) were significantly older, more likely to smoke and had higher BMIs than those without diabetes (n = 7,284). The unadjusted hazard ratio (HR) for OS across all cancer stages was 2.17 (95% CI: 1.90-2.485) and the adjusted HR was 1.69 (95% CI: 1.41-2.04). After further adjusting for vascular diseases, the HR for OS was 1.59 (95% CI: 1.32-1.92). No significant difference was found in chemotherapy receipt. CONCLUSION: We observed significantly poorer OS in women with breast cancer and diabetes across all stages, compared to those without diabetes. Importantly, this persisted after adjusting for confounders and cardiovascular diseases, supporting that diabetes directly influences cancer outcomes.