Skip to main content
SpringerLink
Log in

Impact of Time Since Last Childbirth on Survival of Women with Premenopausal and Postmenopausal Breast Cancers

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Reproductive factors are associated with risk of breast cancer, but the association with breast cancer survival is less well known. Previous studies have reported conflicting results on the association between time since last childbirth and breast cancer survival. We determined the association between time since last childbirth (LCB) and survival of women with premenopausal and postmenopausal breast cancers in Malaysia.

Method

A historical cohort of 986 premenopausal, and 1123 postmenopausal, parous breast cancer patients diagnosed from 2001 to 2012 in University Malaya Medical Centre were included in the analyses. Time since LCB was categorized into quintiles. Multivariable Cox regression was used to determine whether time since LCB was associated with survival following breast cancer, adjusting for demographic, tumor, and treatment characteristics.

Results

Premenopausal breast cancer patients with the most recent childbirth (LCB quintile 1) were younger, more likely to present with unfavorable prognostic profiles and had the lowest 5-year overall survival (OS) (66.9; 95% CI 60.2–73.6%), compared to women with longer duration since LCB (quintile 2 thru 5). In univariable analysis, time since LCB was inversely associated with risk of mortality and the hazard ratio for LCB quintile 2, 3, 4, and 5 versus quintile 1 were 0.53 (95% CI 0.36–0.77), 0.49 (95% CI 0.33–0.75), 0.61 (95% CI 0.43–0.85), and 0.64 (95% CI 0.44–0.93), respectively; P trend = 0.016. However, this association was attenuated substantially following adjustment for age at diagnosis and other prognostic factors. Similarly, postmenopausal breast cancer patients with the most recent childbirth were also more likely to present with unfavorable disease profiles. Compared to postmenopausal breast cancer patients in LCB quintile 1, patients in quintile 5 had a higher risk of mortality. This association was not significant following multivariable adjustment.

Conclusion

Time since LCB is not independently associated with survival in premenopausal or postmenopausal breast cancers. The apparent increase in risks of mortality in premenopausal breast cancer patients with a recent childbirth, and postmenopausal patients with longer duration since LCB, appear to be largely explained by their age at diagnosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. McPherson K, Steel CM, Dixon JM (2000) Breast cancer—epidemiology, risk factors, and genetics. BMJ Br Med J 321(7261):624–628

    Article  CAS  Google Scholar 

  2. Butt Z, Haider SF, Arif S, Khan MR, Ashfaq U, Shahbaz U et al (2012) Breast cancer risk factors: a comparison between pre-menopausal and post-menopausal women. J Pak Med Assoc 62(2):120–124

    PubMed  Google Scholar 

  3. Alsaker MD, Opdahl S, Romundstad PR, Vatten LJ (2013) Association of time since last birth, age at first birth and parity with breast cancer survival among parous women: a register-based study from Norway. Int J Cancer 132(1):174–181

    Article  CAS  PubMed  Google Scholar 

  4. Bladström A, Anderson H, Olsson H (2003) Worse survival in breast cancer among women with recent childbirth: results from a Swedish population-based register study. Clin Breast Cancer 4:280–285

    Article  PubMed  Google Scholar 

  5. Bonnier P, Romain S, Dilhuydy JM, Bonichon F, Julien JP, Charpin C et al (1997) Influence of pregnancy on the outcome of breast cancer: a case-control study. Int J Cancer 72(5):720–727

    Article  CAS  PubMed  Google Scholar 

  6. Daling JR, Malone KE, Doody DR, Anderson BO, Porter PL (2002) The relation of reproductive factors to mortality from breast cancer. Cancer Epidemiol Biomark Prev 11(3):235–241

    Google Scholar 

  7. Mohle-Boetani JC, Grosser S, Whittemore AS, Malec M, Kampert JB, Paffenbarger RS (1988) Body size, reproductive factors, and breast cancer survival. Prev Med 17(5):634–642

    Article  CAS  PubMed  Google Scholar 

  8. Olsen J, Storm H (1998) Pregnancy experience in women who later developed oestrogen-related cancers (Denmark). Cancer Causes Control 9(6):653–657

    Article  CAS  PubMed  Google Scholar 

  9. Phillips KA, Milne RL, Friedlander ML, Jenkins MA, McCredie MR, Giles GG et al (2004) Prognosis of premenopausal breast cancer and childbirth prior to diagnosis. J Clin Oncol 22(4):699–705

    Article  PubMed  Google Scholar 

  10. Whiteman MK, Hillis SD, Curtis KM, McDonald JA, Wingo PA, Marchbanks PA (2004) Reproductive history and mortality after breast cancer diagnosis. Obstet Gynecol 104(1):146–154

    Article  PubMed  Google Scholar 

  11. Largent JA, Ziogas A, Anton-Culver H (2005) Effect of reproductive factors on stage, grade and hormone receptor status in early-onset breast cancer. Breast Cancer Res 7(4):R541–R554

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Olson SH, Zauber AG, Tang J, Harlap S (1998) Relation of time since last birth and parity to survival of young women with breast cancer. Epidemiology 9(6):669–671

    Article  CAS  PubMed  Google Scholar 

  13. Kroman N, Wohlfahrt J, Andersen KW, Mouridsen HT, Westergaard T, Melbye M (1997) Time since childbirth and prognosis in primary breast cancer: population based study. BMJ 315(7112):851–855

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Phillips KA, Milne RL, West DW, Goodwin PJ, Giles GG, Chang ET et al (2009) Prediagnosis reproductive factors and all-cause mortality for women with breast cancer in the breast cancer family registry. Cancer Epidemiol Biomarkers Prev 18(6):1792–1797

    Article  PubMed  PubMed Central  Google Scholar 

  15. Nagatsuma AK, Shimizu C, Takahashi F, Tsuda H, Saji S, Hojo T (2013) Impact of recent parity on histological tumor features and breast cancer outcome in premenopausal Japanese women. Breast Cancer Res Treat 138:941–950

    Article  PubMed  Google Scholar 

  16. Thalib L, Doi SAR, Hall P (2005) Multiple births and breast cancer prognosis: a population based study. Eur J Epidemiol 20(7):613–617

    Article  PubMed  Google Scholar 

  17. Trivers KF, Gammon MD, Abrahamson PE, Lund MJ, Flagg EW, Kaufman JS et al (2007) Association between reproductive factors and breast cancer survival in younger women. Breast Cancer Res Treat 103(1):93–102

    Article  PubMed  Google Scholar 

  18. Rosenberg L, Thalib L, Adami HO, Hall P (2004) Childbirth and breast cancer prognosis. Int J Cancer 111(5):772–776

    Article  CAS  PubMed  Google Scholar 

  19. Allemani C, Weir HK, Carreira H, Harewood R, Spika D, Wang X-S et al (2015) Global surveillance of cancer survival 1995–2009: analysis of individual data for 25 676 887 patients from 279 population-based registries in 67 countries (CONCORD-2). Lancet 385(9972):977–1010

    Article  PubMed  Google Scholar 

  20. Phipps AI, Ichikawa L, Bowles EJA, Carney PA, Kerlikowske K, Miglioretti DL et al (2010) Defining menopausal status in epidemiologic studies: a comparison of multiple approaches and their effects on breast cancer rates. Maturitas 67(1):60–66

    Article  PubMed  PubMed Central  Google Scholar 

  21. Pathy NB, Yip CH, Taib NA, Hartman M, Saxena N, Iau P et al (2011) Breast cancer in a multi-ethnic Asian setting: results from the Singapore–Malaysia hospital-based breast cancer registry. Breast 20(Suppl 2):S75–S80

    Article  PubMed  Google Scholar 

  22. Singletary SE, Greene FL (eds) (2003) Revision of breast cancer staging: the 6th edition of the TNM Classification. Seminars in surgical oncology. Wiley, London

    Google Scholar 

  23. Sterne JAC, White IR, Carlin JB, Spratt M, Royston P, Kenward MG et al (2009) Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls. BMJ 338:b2393

    Article  PubMed  PubMed Central  Google Scholar 

  24. Anders CK, Hsu DS, Broadwater G, Acharya CR, Foekens JA, Zhang Y (2008) Young age at diagnosis correlates with worse prognosis and defines a subset of breast cancer with shared patterns of gene expression. J Clin Oncol 26:3324–3330

    Article  PubMed  Google Scholar 

  25. von Schoultz E, Johansson H, Wilking N, Rutqvist L-E (1995) Influence of prior and subsequent pregnancy on breast cancer prognosis. J Clin Oncol 13(2):430–434

    Article  Google Scholar 

  26. Guinee F, Hess K, Taylor S, Olsson H, Möller T, Fahey T et al (1994) Effect of pregnancy on prognosis for young women with breast cancer. Lancet 343(8913):1587–1589

    Article  CAS  PubMed  Google Scholar 

  27. Ewertz M, Gillanders S, Meyer L, Zedeler K (1991) Survival of breast cancer patients in relation to factors which affect the risk of developing breast cancer. Int J Cancer 49(4):526–530

    Article  CAS  PubMed  Google Scholar 

  28. Butt S, Borgquist S, Garne JP, Landberg G, Tengrup I, Olsson A et al (2009) Parity in relation to survival following breast cancer. Eur J Surg Oncol 35(7):702–708

    Article  CAS  PubMed  Google Scholar 

  29. Gospodarowicz MK, O’Sullivan B, Sobin LH (eds) (2006) Prognostic factors in cancer. Wiley-Liss.

  30. Mueller BA, Simon MS, Deapen D, Kamineni A, Malone KE, Daling JR (2003) Childbearing and survival after breast carcinoma in young women. Cancer 98(6):1131–1140

    Article  PubMed  Google Scholar 

  31. Talamini R, Franceschi S, La Vecchia C, Negri E, Borsa L, Montella M et al (1996) The role of reproductive and menstrual factors in cancer of the breast before and after menopause. Eur J Cancer 32(2):303–310

    Article  Google Scholar 

Download references

Acknowledgements

This study was financially supported by the Ministry of Higher Education Malaysia (High Impact Research Grant [UM.C/HIR/MOHE/06]). We thank Per Hall for helpful discussions.

Author information

Authors and Affiliations

  1. Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Lembah Pantai, 50603, Kuala Lumpur, Malaysia

    Nanthini Balakrishnan, Siamala Sinnadurai, Nanthini Thevi Bhoo Pathy & Nirmala Bhoo Pathy

  2. Cancer Research Malaysia, 1 Jalan SS12/1A, 47500, Subang Jaya, Selangor, Malaysia

    Soo-Hwang Teo & Cheng-Har Yip

  3. Department of Surgery, Faculty of Medicine, University of Malaya, Lembah Pantai, 50603, Kuala Lumpur, Malaysia

    Mee-Hoong See & Nur Aishah Taib

  4. Subang Jaya Medical Centre, 1 Jalan SS12/1A, 47500, Subang Jaya, Selangor, Malaysia

    Cheng-Har Yip

  5. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands

    Nirmala Bhoo Pathy

Authors
  1. Nanthini Balakrishnan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Soo-Hwang Teo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Siamala Sinnadurai
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nanthini Thevi Bhoo Pathy
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mee-Hoong See
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nur Aishah Taib
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Cheng-Har Yip
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Nirmala Bhoo Pathy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nirmala Bhoo Pathy.

Ethics declarations

Conflict of interest

All authors declare no conflict of interest.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 21 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Balakrishnan, N., Teo, SH., Sinnadurai, S. et al. Impact of Time Since Last Childbirth on Survival of Women with Premenopausal and Postmenopausal Breast Cancers. World J Surg 41, 2735–2745 (2017). https://doi.org/10.1007/s00268-017-4081-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-017-4081-9

Search

Navigation