Influence of breast cancer and bone metastases on development of diabetes.

Breast cancer is the most common invasive cancer in American women. Both bone metastases and medications used to treat breast cancer such as aromatase inhibitors may have adverse effects on bone health resulting in risk of fracture.  Bone released factors such as TGF beta contribute to muscle weakness, and impaired insulin secretion which could predispose to development of diabetes in these women. Type 2 diabetes is one of the most common chronic diseases and has been associated with higher incidence and aggressiveness of a variety of cancers, including breast cancer.   However it remains uncertain the frequency in which patients with new diagnosis of breast cancer with or without bone metastases develop new diagnosis of diabetes, and the influence of hormonal therapies for breast cancer, or of bone directed therapies (such as bisphosphonates) on development of new diabetes in this population.
We propose an electronic health records (EHR) and medical informatics approach to identifying the incidence of new diagnoses of diabetes among breast cancer patients and the influence of bone metastases, comorbidities, and various cancer and bone related medications on progression to diabetes, compared to controls. 
In particular this protocol will require the resources of the Regenstrief Institute Data Core, and the Indiana Network for Patient Care, along with the Indiana Department of Health State Cancer Registry to create a deidentified retrospective cohort of breast cancer patients and controls matching on age, race, and sex for the analysis.  Data from the Indiana Department of Health State Cancer Registry will enable us to classify with certainty breast cancer cases, which will then be analyzed based on data within INPC.
In summary, we will use EHR and Medical Informatics to phenotype breast cancer cases and controls using combinations of ICD codes, test records, medications, death records, and natural language processing (NLP; data extraction from text reports) and other information from the Indiana Network for Patient Care (INPC) encompassing a database from multiple clinical data sources in central Indiana organized and integrated by the Regenstrief Institute.