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      Time to follow‐up of an abnormal mammogram in women with diabetes: a population‐based study

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          Women with diabetes have a higher breast cancer incidence and mortality. They are also significantly less likely to undergo screening mammography and present with more advanced stage than women without diabetes. The purpose of this study was to examine if women with diabetes are more likely to have delays in follow‐up of abnormal mammograms, compared to women without diabetes. Using population‐based health databases, this retrospective cohort study examined women between the ages of 50 and 74, with and without diabetes, living in the province of Ontario, Canada, who underwent screening through a centralized program and who had an abnormal mammogram between 2003 and 2012. We compared rates of follow‐up of a diagnostic test within 180 days, as well as likelihood of mastectomy or excision procedure and a diagnosis of breast cancer. Following an abnormal screening mammogram, 97.5% of women with diabetes had a diagnostic procedure within 180 days compared to 97.9% of women without diabetes. After adjustment for other factors, women with diabetes were only 3% less likely to have follow‐up testing after an abnormal mammogram than women without diabetes (hazard ratio [ HR] 0.97, 95% CI: 0.96–0.99, P < 0.001). The majority of Ontario women who underwent screening mammography through a centralized screening program had timely follow‐up of an abnormal mammogram, with no meaningful delays in those who had diabetes. The results of this study suggest that diagnostic delays after screening do not significantly contribute to higher breast cancer mortality in women with diabetes.

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          Diabetes in Ontario: determination of prevalence and incidence using a validated administrative data algorithm.

          Accurate information about the magnitude and distribution of diabetes can inform policy and support health care evaluation. We linked physician service claims (PSCs) and hospital discharge abstracts (HDAs) to determine diabetes prevalence and incidence. A retrospective cohort was constructed using administrative data from the national HDA database, PSCs for Ontario (population 11 million), and registries carrying demographics and vital statistics. All HDAs and PSCs bearing a diagnosis of diabetes (ICD9-CM 250) were selected for 1991-1999. Two previously reported algorithms for identification of diabetes were applied as follows: "1-claim" (any HDA or PSC showing diabetes) and "2-claim" (one HDA or two PSCs within 2 years showing diabetes). Incident cases were defined as individuals who met the criteria for diabetes for the first time after at least 2 years of observation. For validation, diagnostic data abstracted from primary care charts (n=3,317) of 57 randomly selected physicians were linked to the administrative data cohort, and sensitivity and specificity were calculated. -In 1998, 696,938 individuals met the 1-claim criteria and 528,280 met the 2-claim criteria. Sensitivity for diabetes was 90 and 86%; for the 1- and 2-claim algorithms, specificity was 92 and 97%, respectively, and positive predictive values were 61 and 80%, respectively. Using the 2-claim algorithm, the all-age prevalence increased from 3.2% in 1993 to 4.5% in 1998 (6.1% in adults). Incidence remained stable. Administrative data can be used to establish population-based incidence and prevalence of diabetes. Diabetes prevalence is increasing in Ontario and is considerably higher than self-reported rates.
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            Introduction to the Analysis of Survival Data in the Presence of Competing Risks

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              Long-term all-cause mortality in cancer patients with preexisting diabetes mellitus: a systematic review and meta-analysis.

              Diabetes mellitus appears to be a risk factor for some cancers, but the effect of preexisting diabetes on all-cause mortality in newly diagnosed cancer patients is less clear. To perform a systematic review and meta-analysis comparing overall survival in cancer patients with and without preexisting diabetes. We searched MEDLINE and EMBASE through May 15, 2008, including references of qualifying articles. English-language, original investigations in humans with at least 3 months of follow-up were included. Titles, abstracts, and articles were reviewed by at least 2 independent readers. Of 7858 titles identified in our original search, 48 articles met our criteria. One reviewer performed a full abstraction and other reviewers verified accuracy. We contacted authors and obtained additional information for 3 articles with insufficient reported data. Studies reporting cumulative survival rates were summarized qualitatively. Studies reporting Cox proportional hazard ratios (HRs) or Poisson relative risks were combined in a meta-analysis. A random-effects model meta-analysis of 23 articles showed that diabetes was associated with an increased mortality HR of 1.41 (95% confidence interval [CI], 1.28-1.55) compared with normoglycemic individuals across all cancer types. Subgroup analyses by type of cancer showed increased risk for cancers of the endometrium (HR, 1.76; 95% CI, 1.34-2.31), breast (HR, 1.61; 95% CI, 1.46-1.78), and colorectum (HR, 1.32; 95% CI, 1.24-1.41). Patients diagnosed with cancer who have preexisting diabetes are at increased risk for long-term, all-cause mortality compared with those without diabetes.

                Author and article information

                [ 1 ] Department of MedicineUniversity of Toronto TorontoCanada
                [ 2 ]Institute for Clinical Evaluative Sciences TorontoCanada
                [ 3 ] Institute of Health Policy Management and EvaluationUniversity of Toronto TorontoCanada
                [ 4 ]Sunnybrook Health Sciences Centre TorontoCanada
                [ 5 ] Women's College Research InstituteWomen's College Hospital TorontoCanada
                Author notes
                [* ] Correspondence

                Lorraine L. Lipscombe, Women's College Research Institute, Women's College Hospital, 790 Bay St, Room 741, Toronto, ON M5G 1N8, Canada. Tel: 416‐3232‐6400 ext. 5957; Fax: 416‐351‐3746; E‐mail: lorraine.lipscombe@

                Cancer Med
                Cancer Med
                Cancer Medicine
                John Wiley and Sons Inc. (Hoboken )
                06 October 2016
                November 2016
                : 5
                : 11 ( doiID: 10.1002/cam4.2016.5.issue-11 )
                : 3292-3299
                © 2016 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                Figures: 0, Tables: 5, Pages: 8, Words: 5727
                Funded by: Heart and Stroke Foundation
                Funded by: Canadian Institutes of Health Research
                Award ID: MOP#123263
                Funded by: Government of Ontario
                Funded by: Institute for Clinical Evaluative Sciences
                Funded by: Ontario Ministry of Health and Long‐Term Care (MOHLTC)
                Original Research
                Cancer Prevention
                Original Research
                Custom metadata
                November 2016
                Converter:WILEY_ML3GV2_TO_NLMPMC version:4.9.8 mode:remove_FC converted:22.11.2016

                Oncology & Radiotherapy

                breast cancer, cancer screening, diabetes, follow‐up, mammogram


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