Breast cancer is among the most common cancers worldwide. Diabetes is an important chronic health problem associated with insulin resistance, increased insulin level, changes in growth hormones and factors, and activation of mitogen-activating protein kinase (MAPK) pathways, leading to an increased breast cancer risk. This paper looked at the epidemiologic studies of the association between type 2 diabetes and risk of breast cancer and its effect on overall cancer-specific survival. The combined evidence overall supported a modest association between type 2 diabetes and the risk of breast cancer, which was found to be more prevalent among postmenopausal women. Effect of oral diabetics and insulin therapy on breast cancer risk was also evaluated. It was found that metformin and thiazolidinones tended to have a protective role. Metformin therapy trials for its use as an adjuvant for breast cancer treatment are still ongoing. Sulfonylurea and insulin therapy were found to be mildly associated with increased overall cancers. No evidence or studies evaluated the association of DPPIV inhibitors and GLP 1 agonists with breast cancer risk because of their recent introduction into the management of diabetes. 1. Introduction Breast cancer is among the most common cancers worldwide and is the second leading cause of cancer death for women in the United States, after lung cancer, with an estimated incidence of 226,870 cases and estimated deaths of 39,510 cases in the year of 2012. The National Cancer Institute also estimated that 1 in 8 women in the United States has the chance of developing invasive breast cancer throughout her lifetime [1, 2]. Diabetes is also a very common chronic health problem where it is currently estimated that 10% of women in the United States over the age of 20 have type 2 diabetes. Prevalence of diabetes has steadily increased since 1990. The 2010 CDC study projected that by 2050, as many as one of three US adults could have diabetes if the current trend continues [3, 4]. Association between diabetes and breast cancer has been noted where 16% of older breast cancer patients were found to suffer from diabetes, and this might have important public health implications. 2. Pathogenesis Different mechanisms contribute to the association between diabetes and breast cancer. Diabetes induces several changes in different hormonal systems including insulin, insulin-like growth factors, estrogen, and other growth factors, all of which may affect the risk for breast cancer development. As shown in Figure 1, type 2 diabetes mellitus is associated with
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