Association Between Glycated Hemoglobin and Breast Cancer Among Women at a Referral Hospital in Meru County, Kenya A Case-Control Study
Main Article Content
Abstract
The rising dual burden of breast cancer and type 2 diabetes mellitus (T2DM) in Sub-Saharan Africa warrants examining their overlap. This study examined the association between glycated hemoglobin (HbA1c) and breast cancer status at a hospital in Meru County, Kenya. An unmatched case-control study enrolled 285 women: 142 with histologically confirmed breast cancer diagnosis and 143 with benign breast masses. Chi-square, t-tests, ANOVA with Tukey HSD testing, logistic regression, and ROC analysis were used. HbA1c ≥6.5% was present in 84.5% of cases (120/142) versus 34.3% of controls (49/143; χ² = 74.515, df = 1, p < 0.001). Mean HbA1c was higher among cases (6.89% ± 0.75) than controls (5.82% ± 0.71; t (283) = 12.445, p < 0.001, mean difference 1.07, 95% CI: 0.90–1.24). In multivariable logistic regression, T2DM (adjusted OR = 5.619, 95% CI: 2.802–11.267), alcohol use (aOR = 4.041, 95% CI: 1.707–9.569), family history of breast cancer (aOR = 2.763, 95% CI: 1.340–5.587), hormonal contraceptive use (aOR = 2.151, 95% CI: 1.140–4.058), and BMI (aOR = 1.389 per unit, 95% CI: 1.268–1.521) were independently associated with case status; age was not (aOR = 1.000, 95% CI: 0.969–1.033). HbA1c ≥6.5% discriminated cases from controls with moderate accuracy (AUC = 0.751, 95% CI: 0.693–0.809; sensitivity 84.5%, specificity 65.7%). Mean HbA1c did not differ significantly across stages I–III (ANOVA, F(3,139) = 2.599, p = 0.055), although Stage IV cases (n = 8) recorded a higher mean (7.56%) than Stage II (6.78%; Tukey HSD, p = 0.031). Because T2DM status was derived from the HbA1c ≥6.5% threshold, and HbA1c was measured post-diagnosis, findings reflect association within this sample rather than validated screening performance. Glycemic status shows a strong association with breast cancer in this Kenyan population; prospective population-based studies are needed before HbA1c can be recommended as a breast cancer screening tool.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
I/We agree to transfer the copyright of this manuscript to the International Journal of Professional Practice (The IJPP) in the event that the manuscript is published in the Journal.
I/We give the undersigned authors of the manuscript have made the following declaration:
(a) That I/We have made substantial contribution during the conception and design, or acquisition of data, or analysis and interpretation of the data,
(b) That I/We have participated in drafting the article or revising it critically for important intellectual content,
(c) That I/We have read and confirm the content of the manuscript and have agreed to it,
(d) That I/We have participated sufficiently in the work to take public responsibility for appropriate portions of the content of the paper,
(e) That I/We give guarantee that the content of the manuscript is original, and has not beenvpublished elsewhere and is not currently being considered for publication by another journal.
References
Adedokun, B., Ademola, A., Makumbi, T., Odedina, S., Agwai, I., Ndom, P., Gakwaya, A., Ogundiran, T., Ojengbede, O., Huo, D., & Olopade, O. I. (2023). Unawareness of breast cancer family history among African women. Pan African Medical Journal, 45, Article 188. https://doi.org/10.11604/pamj.2023.45.188.21616 DOI: https://doi.org/10.11604/pamj.2023.45.188.21616
Antabe, R., Kansanga, M., Sano, Y., Kyeremeh, E., & Galaa, Y. (2020). Utilization of breast cancer screening in Kenya: What are the determinants? BMC Health Services Research, 20, Article 228. https://doi.org/10.1186/s12913-020-5073-2 DOI: https://doi.org/10.1186/s12913-020-5073-2
Asiri, A., Al Qarni, A., Bakillah, A., & Arabia, S. (2024). The interlinking metabolic association between type 2 diabetes mellitus and cancer: Molecular mechanisms and therapeutic insights. Diagnostics, 14(19), Article 2132. https://doi.org/10.3390/diagnostics14192132 DOI: https://doi.org/10.3390/diagnostics14192132
Ayoub, N. M., Jaradat, S. K., Alhusban, A., & Tahaineh, L. (2020). Glycosylated hemoglobin A1c is associated with anthropometric measurements and tumor characteristics in breast cancer patients. International Journal of Women's Health, 12, 139–149. https://doi.org/10.2147/ijwh.s234408 DOI: https://doi.org/10.2147/IJWH.S234408
Bjornsdottir, H. H., Rawshani, A., Rawshani, A., Franzen, S., Svensson, A. M., Sattar, N., & Gudbjornsdottir, S. (2020). A national observation study of cancer incidence and mortality risks in type 2 diabetes compared to the background population over time. Scientific Reports, 10, Article 17376. https://doi.org/10.1038/s41598-020-74366-3 DOI: https://doi.org/10.1038/s41598-020-73668-y
Campbell, P. T., Newton, C. C., Jacobs, E. J., McCullough, M. L., Wang, Y., Rees-Punia, E., Guinter, M. A., Murphy, N., Koshiol, J., Dehal, A. N., Rohan, T., Strickler, H., Petrick, J., Gunter, M., Zhang, X., McGlynn, K. A., Pollak, M., Patel, A. V., & Gapstur, S. M. (2022). Prospective associations of hemoglobin A1c and C-peptide with risk of diabetes-related cancers in the Cancer Prevention Study-II Nutrition Cohort. Cancer Research Communications, 2(7), 653–662. https://doi.org/10.1158/2767-9764.crc-22-0082 DOI: https://doi.org/10.1158/2767-9764.CRC-22-0082
Cosmin Stan, M., & Paul, D. (2024). Diabetes and cancer: A twisted bond. Oncology Reviews, 18, Article 1354549. https://doi.org/10.3389/or.2024.1354549 DOI: https://doi.org/10.3389/or.2024.1354549
Durrani, I. A., Bhatti, A., & John, P. (2021). The prognostic outcome of "type 2 diabetes mellitus and breast cancer" association pivots on hypoxia-hyperglycemia axis. Cancer Cell International, 21, Article 172. https://doi.org/10.1186/s12935-021-02040-5 DOI: https://doi.org/10.1186/s12935-021-02040-5
Fitzpatrick, D., Pirie, K., Reeves, G., Green, J., & Beral, V. (2023). Combined and progestagen-only hormonal contraceptives and breast cancer risk: A UK nested case-control study and meta-analysis. PLOS Medicine, 20(3), Article e1004188. https://doi.org/10.1371/journal.pmed.1004188 DOI: https://doi.org/10.1371/journal.pmed.1004188
Fleiss, J. L., Levin, B., & Paik, M. C. (2003). Statistical methods for rates and proportions (3rd ed.). Wiley. https://doi.org/10.1002/0471445428 DOI: https://doi.org/10.1002/0471445428
Giovannucci, E., Harlan, D. M., Archer, M. C., Bergenstal, R. M., Gapstur, S. M., Habel, L. A., Pollak, M., Regensteiner, J. G., & Yee, D. (2010). Diabetes and cancer: A consensus report. Diabetes Care, 33(7), 1674–1685. https://doi.org/10.2337/dc10-0666 DOI: https://doi.org/10.2337/dc10-0666
Glassman, I., Le, N., Asif, A., Goulding, A., Alcantara, C. A., Vu, A., Chorbajian, A., Mirhosseini, M., Singh, M., & Venketaraman, V. (2023). The role of obesity in breast cancer pathogenesis. Cells, 12(16), Article 2061. https://doi.org/10.3390/cells12162061 DOI: https://doi.org/10.3390/cells12162061
Hu, J., Geng, T., Li, L., Pan, A., & Liu, G. (2021). Association of time since diabetes diagnosis with cardiovascular and cancer outcomes. JAMA Network Open, 4(12), Article e2138560. https://doi.org/10.1001/jamanetworkopen.2021.38560
Hutchinson, B., Watts, R., Nyangasi, M., Anderson, B., Chepchumba, J., Wangia, E., Jalang', R., Mwenda, V., Yerramilli, P., Kuguru, T., Kabubei, K., Gordillo-Tobar, A., Meheus, F., Meyer, C., Ilbawi, A., & Nugent, R. (2024). An economic evaluation of breast cancer interventions in Kenya. eClinicalMedicine, 77, Article 102894. https://doi.org/10.1016/j.eclinm.2024.102894 DOI: https://doi.org/10.1016/j.eclinm.2024.102894
Jousheghany, F., Phelps, J., Crook, T., & Hakkak, R. (2016). Relationship between level of HbA1c and breast cancer. BBA Clinical, 6, 45–48. https://doi.org/10.1016/j.bbacli.2016.04.005 DOI: https://doi.org/10.1016/j.bbacli.2016.04.005
Kivuyo, S., Bottomley, C., Lora, W., Mahendeka, M., Kasirye, P., Jaffar, S., & Group, I. T. (2023). Integration of HIV, diabetes, and hypertension services: A cluster-randomised trial in sub-Saharan Africa (INTE-AFRICA). PLOS Medicine, 20(2), Article e1004175. https://doi.org/10.1371/journal.pmed.1004175 DOI: https://doi.org/10.1371/journal.pmed.1004175
Lam, B. Q., Srivastava, R., Morvant, J., Shankar, S., & Srivastava, R. K. (2021). Association of diabetes mellitus and alcohol abuse with cancer: Molecular mechanisms and clinical significance. Cells, 10(11), Article 3077. https://doi.org/10.3390/cells10113077 DOI: https://doi.org/10.3390/cells10113077
Liang, X.-Y., Mu, L., Hu, L., She, R., Ma, C., Feng, J., Jiang, Z., Li, Z., Qu, X., Peng, B., Wu, K., & Kong, L. (2024). Optimal glycated hemoglobin cutoff for diagnosis of diabetes and prediabetes in Chinese breast cancer women. International Journal of General Medicine, 17, 1807–1822. https://doi.org/10.2147/ijgm.s457158 DOI: https://doi.org/10.2147/IJGM.S457158
Ngwa, W., Addai, B. W., Adewole, I., Ainsworth, V., Alaro, J., Alatise, O. I., Ali, Z., Anderson, B. O., Anorlu, R., Avery, S., & et al. (2022). Cancer in sub-Saharan Africa: A Lancet Oncology Commission. The Lancet Oncology, 23(6), e251–e312. https://doi.org/10.1016/s1470-2045(21)00720-8 DOI: https://doi.org/10.1016/S1470-2045(21)00720-8
Nolte, E., Conklin, A., Adams, J., Brunn, M., Cadier, B., Chevreul, K., Durand-Zaleski, I., Elissen, A., Erler, A., Flamm, M., Frølich, A., Katterl, R., Leijten, F., Llano, R., Maguerez, G., Miani, C., Noseworthy, T., Rijken, M., Santaolalla, M., & Vrijhoef, H. J. M. (2012). Evaluating chronic disease management: Recommendations for a European framework. European Observatory on Health Systems and Policies. https://apps.who.int/iris/handle/10665/326319
Riogi, B., Ross, C., Mutebi, M., & Dave, R. V. (2022). The Kenya UK Breast Cancer Awareness Week: Curriculum codesign and codelivery with direct and lived experience of breast cancer diagnosis and management. BMJ Global Health, 7(5), Article e008755. https://doi.org/10.1136/bmjgh-2022-008755 DOI: https://doi.org/10.1136/bmjgh-2022-008755
Rioki, J. N., Muchiri, L., Mweu, M., Nyagol, J., Songok, E., Mwangi, J., Oyaro, M., Bwire, L., & Rogena, E. (2023). BRCA1 and BRCA2 mutations and their clinical relevance in selected women diagnosed with triple-negative breast cancer in Kenya: A descriptive cross-sectional study. Pan African Medical Journal, 45, Article 102. https://doi.org/10.11604/pamj.2023.45.102.36431 DOI: https://doi.org/10.11604/pamj.2023.45.102.36431
Sayed, S., Moloo, Z., Wasike, R., Bird, P., Oigara, R., Njoroge, F. W., Shaikh, A. J., Prasad, S. V., Vinayak, S., Gierach, G. L., Dawsey, S. M., Palakal, M., Fan, S., Mullooly, M., Chauhan, R., Okiro, P., Gakinya, S., Nzioka, A., Kyobutungi, C., & Mohamed, S. (2017). Ethnicity and breast cancer characteristics in Kenya. Breast Cancer Research and Treatment, 167(2), 425–437. https://doi.org/10.1007/s10549-017-4511-2 DOI: https://doi.org/10.1007/s10549-017-4511-2
Sayed, S., Fan, S., Moloo, Z., Wasike, R., Bird, P., Saleh, M., Shaikh, A. J., Figueroa, J. D., Naidoo, R., Makokha, F. W., Gardner, K., Oigara, R., Njoroge, F. W., Magangane, P., Mutebi, M., Chauhan, R., Mwanzi, S., Govender, D., & Yang, X. R. (2021). Breast cancer risk factors in relation to molecular subtypes in breast cancer patients from Kenya. Breast Cancer Research, 23, Article 19. https://doi.org/10.1186/s13058-021-01446-3 DOI: https://doi.org/10.1186/s13058-021-01446-3
Shikata, K., Ninomiya, T., & Kiyohara, Y. (2013). Diabetes mellitus and cancer risk: Review of the epidemiological evidence. Cancer Science, 104(1), 9–14. https://doi.org/10.1111/cas.12043 DOI: https://doi.org/10.1111/cas.12043
Stattin, P., Bjor, O., Ferrari, P., Lukanova, A., Lenner, P., Lindahl, B., Hallmans, G., & Kaaks, R. (2007). Prospective study of hyperglycemia and cancer risk. Diabetes Care, 30(3), 561–567. https://doi.org/10.2337/dc06-0922 DOI: https://doi.org/10.2337/dc06-0922
Twahir, M., Oyesegun, R., Yarney, J., Gachii, A., Nwogu, C., Mangutha, G., Anderson, P., & Benjamin, E. (2021). Real-world challenges for patients with breast cancer in sub-Saharan Africa: A retrospective observational study of access to care in Ghana, Kenya and Nigeria. BMJ Open, 11(5), Article e041900. https://doi.org/10.1136/bmjopen-2020-041900 DOI: https://doi.org/10.1136/bmjopen-2020-041900
Vander Heiden, M. G., Cantley, L. C., & Thompson, C. B. (2009). Understanding the Warburg effect: The metabolic requirements of cell proliferation. Science, 324(5930), 1029–1033. https://doi.org/10.1126/science.1160809 DOI: https://doi.org/10.1126/science.1160809
Wassie, M., Zegeye, A. F., Aemro, A., Terefe, B., Zeleke, G. A., Workneh, B. S., Tekeba, B., Ali, M. S., Mekonen, E. G., & Tamir, T. T. (2024). Awareness and its determinant factors towards breast examination to detect breast cancer among reproductive age women in Kenya: Multilevel analysis of the recent demographic and health survey data. PLOS ONE, 19(12), Article e0314700. https://doi.org/10.1371/journal.pone.0314700 DOI: https://doi.org/10.1371/journal.pone.0314700
World Health Organization Regional Office for Africa. (2025). Women's integrated cancer services (WICS) project. WHO AFRO. https://www.afro.who.int
Zhang, F., de Bock, G. H., Landman, G. W., Zhang, Q., van der Vegt, B., & Sidorenkov, G. (2025). Longitudinal changes in metabolism-related metrics and breast cancer risk: A general population study. Breast Cancer Research, 27, Article 33. https://doi.org/10.1186/s13058-025-02105-7 DOI: https://doi.org/10.1186/s13058-025-02105-7
Zhang, J., Lu, Y., Zhang, N., Yu, Z., Li, H., He, R., Mao, Y., & Zhu, B. (2023). Global burden of female breast cancer and its association with socioeconomic development status, 1990–2044. Cancer Reports, 6(S1), Article e1827. https://doi.org/10.1002/cnr2.1827 DOI: https://doi.org/10.1002/cnr2.1827