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The Impact of Diabetes on Gynecologic Cancer: Current Status and Future Directions

  • Gynecologic Oncology (R Salani, Section Editor)
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Abstract

Diabetes mellitus has reached epidemic proportions in both the USA and worldwide with most authorities reporting a doubling in the prevalence of diabetes over the last 20–30 years. While this epidemic is closely tied to obesity, diabetes mellitus presents potential clinical challenges over and above that observed with obesity alone. From a women’s healthcare prospective, this rise in diabetes may impact a woman’s health across her lifespan. More specifically, diabetes impacts not only pregnancy as well as other medical conditions but increases the risk for the development of various malignancies. From a gynecologic cancer standpoint, diabetes is most closely associated with endometrial adenocarcinomas, although increasing attention is being placed upon diabetes and ovarian cancer. Attention is also being placed on the potential role of metformin and its impact on outcomes in diabetics with cancer, as well as a potential preventative and/or adjunctive therapy for gynecologic cancer.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Organization W.H. Global status report on noncommunicable diseases 2014. Geneza: World Health Organization; 2014.

    Google Scholar 

  2. Zimmet PZ et al. Diabetes: a 21st century challenge. Lancet Diabet Endocrinol. 2014;2(1):56–64.

    Article  Google Scholar 

  3. Chen L, Magliano DJ, Zimmet PZ. The worldwide epidemiology of type 2 diabetes mellitus—present and future perspectives. Nat Rev Endocrinol. 2012;8(4):228–36.

    Article  CAS  Google Scholar 

  4. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015;65(1):5–29.

    Article  PubMed  Google Scholar 

  5. Romero IL et al. Relationship of type II diabetes and metformin use to ovarian cancer progression, survival, and chemosensitivity. Obstet Gynecol. 2012;119(1):61–7. Although containing a limited number of diabetics receiving metformin, 16 of 44 diabetic patients, the marked difference in outcomes when compared to both non-diabetics as well as diabetics not on metformin was quite provocative.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Shah MM et al. Diabetes mellitus and ovarian cancer: more complex than just increasing risk. Gynecol Oncol. 2014;135(2):273–7. More recent series that again demonstrates inferior ovarian cancer survival for diabetics, with generally similar clinical covariates, when compared to non-diabetics.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Bakhru A, Buckanovich RJ, Griggs JJ. The impact of diabetes on survival in women with ovarian cancer. Gynecol Oncol. 2011;121(1):106–11.

    Article  PubMed  Google Scholar 

  8. Prevention C.f.D.C.a. National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, 2014. 2014; Available from: http://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf.

  9. Stine JE, Bae-Jump V. Metformin and gynecologic cancers. Obstet Gynecol Surv. 2014;69(8):477–89.

    Article  PubMed  Google Scholar 

  10. Friberg E et al. Diabetes mellitus and risk of endometrial cancer: a meta-analysis. Diabetologia. 2007;50(7):1365–74.

    Article  CAS  PubMed  Google Scholar 

  11. Liu X, et al. Cancer risk in patients with type 2 diabetes mellitus and their relatives. Int J Cancer. 2015.

  12. Luo J et al. Association between diabetes, diabetes treatment and risk of developing endometrial cancer. Br J Cancer. 2014;111(7):1432–9.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  13. Stocks T, et al. Metabolic risk score and cancer risk: pooled analysis of seven cohorts. Int J Epidemiol. 2015.

  14. Trabert B et al. Metabolic syndrome and risk of endometrial cancer in the United States: a study in the SEER-medicare linked database. Cancer Epidemiol Biomarkers Prev. 2015;24(1):261–7.

    Article  PubMed  Google Scholar 

  15. Esposito K et al. Metabolic syndrome and endometrial cancer: a meta-analysis. Endocrine. 2014;45(1):28–36.

    Article  CAS  PubMed  Google Scholar 

  16. Zanders MM et al. Effect of diabetes on endometrial cancer recurrence and survival. Maturitas. 2013;74(1):37–43.

    Article  PubMed  Google Scholar 

  17. Bailey CJ, Turner RC. Metformin. N Engl J Med. 1996;334(9):574–9.

    Article  CAS  PubMed  Google Scholar 

  18. Quinn BJ et al. Repositioning metformin for cancer prevention and treatment. Trends Endocrinol Metab. 2013;24(9):469–80.

    Article  CAS  PubMed  Google Scholar 

  19. Evans JM et al. Metformin and reduced risk of cancer in diabetic patients. BMJ. 2005;330(7503):1304–5.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Soffer D et al. Metformin and breast and gynecological cancer risk among women with diabetes. BMJ Open Diabetes Res Care. 2015;3(1):e000049.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Currie CJ et al. Mortality after incident cancer in people with and without type 2 diabetes: impact of metformin on survival. Diabetes Care. 2012;35(2):299–304.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Nevadunsky NS et al. Metformin use and endometrial cancer survival. Gynecol Oncol. 2014;132(1):236–40.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  23. Ko EM et al. Metformin and the risk of endometrial cancer: a population-based cohort study. Gynecol Oncol. 2015;136(2):341–7.

    Article  CAS  PubMed  Google Scholar 

  24. Tabrizi AD et al. Antiproliferative effect of metformin on the endometrium—a clinical trial. Asian Pac J Cancer Prev. 2014;15(23):10067–70.

    Article  PubMed  Google Scholar 

  25. Cantrell LA et al. Metformin is a potent inhibitor of endometrial cancer cell proliferation—implications for a novel treatment strategy. Gynecol Oncol. 2010;116(1):92–8.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  26. Mitsuhashi A et al. Effects of metformin on endometrial cancer cell growth in vivo: a preoperative prospective trial. Cancer. 2014;120(19):2986–95.

    Article  CAS  PubMed  Google Scholar 

  27. Hanna RK et al. Metformin potentiates the effects of paclitaxel in endometrial cancer cells through inhibition of cell proliferation and modulation of the mTOR pathway. Gynecol Oncol. 2012;125(2):458–69.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  28. Uehara T et al. Metformin potentiates the anticancer effects of cisplatin under normoxic conditions in vitro. Oncol Rep. 2015;33(2):744–50.

    CAS  PubMed  Google Scholar 

  29. Morgan Jr RJ et al. Ovarian cancer, version 2.2013. J Natl Compr Canc Netw. 2013;11(10):1199–209.

    CAS  PubMed  Google Scholar 

  30. Tewari D et al. Long-term survival advantage and prognostic factors associated with intraperitoneal chemotherapy treatment in advanced ovarian cancer: a gynecologic oncology group study. J Clin Oncol. 2015;33(13):1460–6.

    Article  CAS  PubMed  Google Scholar 

  31. Landrum LM et al. Prognostic factors for stage III epithelial ovarian cancer treated with intraperitoneal chemotherapy: a Gynecologic Oncology Group study. Gynecol Oncol. 2013;130(1):12–8.

    Article  PubMed  Google Scholar 

  32. Olsen CM et al. Obesity and the risk of epithelial ovarian cancer: a systematic review and meta-analysis. Eur J Cancer. 2007;43(4):690–709.

    Article  PubMed  Google Scholar 

  33. Protani MM, Nagle CM, Webb PM. Obesity and ovarian cancer survival: a systematic review and meta-analysis. Cancer Prev Res (Phila). 2012;5(7):901–10.

    Article  Google Scholar 

  34. Yang HS et al. Effect of obesity on survival of women with epithelial ovarian cancer: a systematic review and meta-analysis of observational studies. Int J Gynecol Cancer. 2011;21(9):1525–32.

    Article  PubMed  Google Scholar 

  35. Collaborative Group on Epidemiological Studies of Ovarian, C. Ovarian cancer and body size: individual participant meta-analysis including 25,157 women with ovarian cancer from 47 epidemiological studies. PLoS Med. 2012;9(4):e1001200.

    Article  Google Scholar 

  36. Ma X et al. Anthropometric measures and epithelial ovarian cancer risk among Chinese women: results from the Shanghai Women’s Health Study. Br J Cancer. 2013;109(3):751–5.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  37. Kalli KR, Conover CA. The insulin-like growth factor/insulin system in epithelial ovarian cancer. Front Biosci. 2003;8:d714–22.

    Article  CAS  PubMed  Google Scholar 

  38. Lukanova A, Kaaks R. Endogenous hormones and ovarian cancer: epidemiology and current hypotheses. Cancer Epidemiol Biomarkers Prev. 2005;14(1):98–107.

    CAS  PubMed  Google Scholar 

  39. Howe LR et al. Molecular pathways: adipose inflammation as a mediator of obesity-associated cancer. Clin Cancer Res. 2013;19(22):6074–83.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  40. Joung KH, Jeong JW, Ku BJ. The association between type 2 diabetes mellitus and women cancer: the epidemiological evidences and putative mechanisms. Biomed Res Int. 2015;2015:920618.

    Article  PubMed Central  PubMed  Google Scholar 

  41. Nagle CM, et al. Obesity and survival among women with ovarian cancer: results from the Ovarian Cancer Association Consortium. Br J Cancer. 2015.

  42. Nagle CM et al. Carbohydrate intake, glycemic load, glycemic index, and risk of ovarian cancer. Ann Oncol. 2011;22(6):1332–8.

    Article  CAS  PubMed  Google Scholar 

  43. Lee JY et al. Diabetes mellitus and ovarian cancer risk: a systematic review and meta-analysis of observational studies. Int J Gynecol Cancer. 2013;23(3):402–12.

    Article  PubMed  Google Scholar 

  44. Febbraro T, Lengyel E, Romero IL. Old drug, new trick: repurposing metformin for gynecologic cancers? Gynecol Oncol. 2014;135(3):614–21.

    Article  CAS  PubMed  Google Scholar 

  45. Lengyel E et al. Metformin inhibits ovarian cancer growth and increases sensitivity to paclitaxel in mouse models. Am J Obstet Gynecol. 2015;212(4):479. e1-479 e10.

    Article  CAS  PubMed  Google Scholar 

  46. Bodmer M et al. Use of metformin and the risk of ovarian cancer: a case–control analysis. Gynecol Oncol. 2011;123(2):200–4.

    Article  CAS  PubMed  Google Scholar 

  47. Kumar S et al. Metformin intake is associated with better survival in ovarian cancer: a case–control study. Cancer. 2013;119(3):555–62. Well designed case–control study again noting differential impacts on survival in women utilizing metformin with superior survival in those on metformin therapy.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

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Conflict of Interest

Brittany Lees declares no conflict of interest.

Charles A. Leath, III declares contracted research in Ovarian Cancer from Novartis and from Astra Zeneza, outside the submitted work.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Support

Funding support was provided in part by NIH to CAL 5K12HD0012580-15.

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Correspondence to Charles A. Leath III.

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This article is part of the Topical Collection on Gynecologic Oncology

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Lees, B., Leath, C.A. The Impact of Diabetes on Gynecologic Cancer: Current Status and Future Directions. Curr Obstet Gynecol Rep 4, 234–239 (2015). https://doi.org/10.1007/s13669-015-0127-x

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  • DOI: https://doi.org/10.1007/s13669-015-0127-x

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