World Journal of Surgery

, Volume 41, Issue 11, pp 2735–2745 | Cite as

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

  • Nanthini Balakrishnan
  • Soo-Hwang Teo
  • Siamala Sinnadurai
  • Nanthini Thevi Bhoo Pathy
  • Mee-Hoong See
  • Nur Aishah Taib
  • Cheng-Har Yip
  • Nirmala Bhoo PathyEmail author
Original Scientific Report



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.


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.


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.


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 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.

Compliance with ethical standards

Conflict of interest

All authors declare no conflict of interest.

Supplementary material

268_2017_4081_MOESM1_ESM.docx (22 kb)
Supplementary material 1 (DOCX 21 kb)


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Copyright information

© Société Internationale de Chirurgie 2017

Authors and Affiliations

  • Nanthini Balakrishnan
    • 1
  • Soo-Hwang Teo
    • 2
  • Siamala Sinnadurai
    • 1
  • Nanthini Thevi Bhoo Pathy
    • 1
  • Mee-Hoong See
    • 3
  • Nur Aishah Taib
    • 3
  • Cheng-Har Yip
    • 2
    • 4
  • Nirmala Bhoo Pathy
    • 1
    • 5
    Email author
  1. 1.Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of MedicineUniversity of MalayaKuala LumpurMalaysia
  2. 2.Cancer Research MalaysiaSubang JayaMalaysia
  3. 3.Department of Surgery, Faculty of MedicineUniversity of MalayaKuala LumpurMalaysia
  4. 4.Subang Jaya Medical CentreSubang JayaMalaysia
  5. 5.Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands

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