High fasting blood glucose and obesity significantly and independently increase risk of breast cancer death in hormone receptor-positive disease

Eur J Cancer. 2013 Dec;49(18):3881-8. doi: 10.1016/j.ejca.2013.08.004. Epub 2013 Sep 3.


Purpose: We investigated the effect of fasting blood glucose and body mass index (BMI) at diagnosis on risk of breast cancer death for cases diagnosed in five Italian cancer registries in 2003-2005 and followed up to the end of 2008.

Methods: For 1607 Italian women (≥15 years) with information on BMI or blood glucose or diabetes, we analysed the risk of breast cancer death in relation to glucose tertiles (≤84.0, 84.1-94.0, >94.0 mg/dl) plus diabetic and unspecified categories; BMI tertiles (≤23.4, 23.5-27.3, >27.3 kg/m(2), unspecified), stage (T1-3N0M0, T1-3N+M0 plus T4anyNM0, M1, unspecified), oestrogen (ER) and progesterone (PR) status (ER+PR+, ER-PR-, ER and PR unspecified, other), age, chemotherapy and endocrine therapy, using multiple regression models. Separate models for ER+PR+ and ER-PR- cases were also run.

Results: Patients often had T1-3N0M0, ER+PR+ cancers and received chemotherapy or endocrine therapy; only 6% were M1 and 17% ER-PR-. Diabetic patients were older and had more often high BMI (>27 kg/m(2)), ER-PR-, M1 cancers than other patients. For ER+PR+ cases, with adjustment for other variables, breast cancer mortality was higher in women with high BMI than those with BMI 23.5-27.3 kg/m(2) (hazard ratio (HR)=2.9, 95% confidence interval (CI) 1.2-6.9). Breast cancer mortality was also higher in women with high (>94 mg/dl) blood glucose compared to those with glucose 84.1-94.0mg/dl (HR=2.6, 95% CI 1.2-5.7).

Conclusion: Our results provide evidence that in ER+PR+ patients, high blood glucose and high BMI are independently associated with increased risk of breast cancer death. Detection and correction of these factors in such patients may improve prognosis.

Keywords: Blood glucose; Breast cancer; Hormone receptor status; Obesity; Risk of death.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Blood Glucose / metabolism*
  • Body Mass Index
  • Breast Neoplasms / complications
  • Breast Neoplasms / metabolism
  • Breast Neoplasms / mortality*
  • Diabetes Complications
  • Fasting / blood*
  • Female
  • Humans
  • Italy
  • Logistic Models
  • Middle Aged
  • Multivariate Analysis
  • Obesity / complications*
  • Receptors, Estrogen / metabolism
  • Receptors, Progesterone / metabolism
  • Registries / statistics & numerical data
  • Risk Assessment
  • Risk Factors
  • Survival Rate
  • Young Adult


  • Blood Glucose
  • Receptors, Estrogen
  • Receptors, Progesterone