Breast Cancer Risk After Recent Childbirth: A Pooled Analysis of 15 Prospective Studies.
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Nichols Hazel B, Schoemaker Minouk J, Cai Jianwen, Xu Jiawei, Wright Lauren B, Brook Mark N, Jones Michael E, Adami Hans-Olov, Baglietto Laura, Bertrand Kimberly A, Blot William J, Boutron-Ruault Marie-Christine, Dorronsoro Miren, Dossus Laure, Eliassen A Heather, Giles Graham G, Gram Inger T, Hankinson Susan E, Hoffman-Bolton Judy, Kaaks Rudolf, Key Timothy J, Kitahara Cari M, Larsson Susanna C, Linet Martha, Merritt Melissa A, Milne Roger L, Pala Valeria, Palmer Julie R, Peeters Petra H, Riboli Elio, Sund Malin, Tamimi Rulla M, Tjønneland Anne, Trichopoulou Antonia, Ursin Giske, Vatten Lars, Visvanathan Kala, Weiderpass Elisabete, Wolk Alicja, Zheng Wei, Weinberg Clarice R, Swerdlow Anthony J, Sandler Dale P
Аннотация
OBJECTIVE: To characterize breast cancer risk in relation to recent childbirth.
DESIGN: Pooled analysis of individual-level data from 15 prospective cohort studies.
SETTING: The international Premenopausal Breast Cancer Collaborative Group.
PARTICIPANTS: Women younger than 55 years.
MEASUREMENTS: During 9.6 million person-years of follow-up, 18 826 incident cases of breast cancer were diagnosed. Hazard ratios (HRs) and 95% CIs for breast cancer were calculated using Cox proportional hazards regression.
RESULTS: Compared with nulliparous women, parous women had an HR for breast cancer that peaked about 5 years after birth (HR, 1.80 [95% CI, 1.63 to 1.99]) before decreasing to 0.77 (CI, 0.67 to 0.88) after 34 years. The association crossed over from positive to negative about 24 years after birth. The overall pattern was driven by estrogen receptor (ER)-positive breast cancer; no crossover was seen for ER-negative cancer. Increases in breast cancer risk after childbirth were pronounced when combined with a family history of breast cancer and were greater for women who were older at first birth or who had more births. Breastfeeding did not modify overall risk patterns.
LIMITATIONS: Breast cancer diagnoses during pregnancy were not uniformly distinguishable from early postpartum diagnoses. Data on human epidermal growth factor receptor 2 (HER2) oncogene overexpression were limited.
CONCLUSION: Compared with nulliparous women, parous women have an increased risk for breast cancer for more than 20 years after childbirth. Health care providers should consider recent childbirth a risk factor for breast cancer in young women.
PRIMARY FUNDING SOURCE: The Avon Foundation, the National Institute of Environmental Health Sciences, Breast Cancer Now and the UK National Health Service, and the Institute of Cancer Research.