Virchows Archiv

, Volume 443, Issue 1, pp 44–50 | Cite as

Pregnancy and breast cancer: a population-based study

  • W. Reed
  • E. Hannisdal
  • E. Skovlund
  • S. Thoresen
  • P. Lilleng
  • J. M. Nesland
Original Article

Abstract

The incidence of pregnancy-associated breast cancer, i.e. during pregnancy and lactation, and of pregnancy subsequent to a breast-cancer diagnosis will increase as more women choose childbearing at a later age. Few larger series are published on pregnancy-associated breast cancer. In a population-based study, we evaluated the outcome and prognostic factors in 173 breast-cancer patients. One hundred and twenty-two patients had pregnancy-associated breast cancer (20 coincident with pregnancy and 102 during lactation) and 51 patients had pregnancy subsequent to breast cancer. The median follow-up time was 151 months. Histopathological parameters and immunoreactivity for oestrogen and progesterone receptors c-erbB-2 and c-erbB-4 were studied. All three groups had tumours with high histological grade, low frequency of hormone receptors and high expression of c-erbB-2. The pregnancy and lactation groups were near identical with regard to all histopathological parameters and outcome. In the two pregnancy-associated breast-cancer groups, tumours were significantly larger, with more extensive lymph-node involvement. For node-negative tumours the respective 5- and 10-year survival rates were 62% and 50% in the pregnancy group and 60% and 50% in the lactation group. For node-positive tumours, respective 5- and 10-year survival rates were 50% and 34% in the pregnancy group and 50% and 33% in the lactation group. In the subsequent group, overall survival was high in both node-negative and -positive groups, with 5- and 10-year survival rates of 80% and 73% and 86% and 76%, respectively. Tumour size, lymph-node status, histological grade, progesterone receptor, oestrogen receptor and c-erbB-2 were significant prognostic factors in the pregnancy-associated breast-cancer patients.

Keywords

Pregnancy Breast cancer Hormone receptor c-erbB-2 c-erbB-4 Prognostic factors 

References

  1. 1.
    Adami HO, Malker B, Holmberg L, Persson I, Stone B (1986) The relation between survival and age at diagnosis in breast cancer. N Engl J Med 315:559–563PubMedGoogle Scholar
  2. 2.
    Anderson BO, Petrek JA, Byrd DR, Senie RT, Borgen PI (1996) Pregnancy influences breast cancer stage at diagnosis in women 30 years of age and younger. Ann Surg Oncol 3:204–211PubMedGoogle Scholar
  3. 3.
    Bloom HJG (1957) Histological grading and prognosis in breast cancer. Br J Cancer 11:359–373Google Scholar
  4. 4.
    Bonnier P, Romain S, Charpin C, Lejeune C, Tubiana N, Martin PM, et al (1995) Age as a prognostic factor in breast cancer: relationship to pathologic and biologic features. Int J Cancer 62:138–144PubMedGoogle Scholar
  5. 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 72:720–727CrossRefPubMedGoogle Scholar
  6. 6.
    Chung M, Chang HR, Bland KI, Wanebo HJ (1996) Younger women with breast carcinoma have a poorer prognosis than older women. Cancer 77:97–103CrossRefPubMedGoogle Scholar
  7. 7.
    Crombie N, Rampaul RS, Pinder SE, Elston CW, Robertson JF, Ellis IO (2001) Extent of ductal carcinoma in situ within and surrounding invasive primary breast carcinoma. Br J Surg 88:1324–1329CrossRefPubMedGoogle Scholar
  8. 8.
    de-la-Rochefordiere A, Asselain B, Campana F, Scholl SM, Fenton J, Vilcoq JR, et al (1993) Age as prognostic factor in premenopausal breast carcinoma. Lancet 341:1039–1043PubMedGoogle Scholar
  9. 9.
    De Potter CR, Quatacker J, Maertens G, Van Daele S, Pauwels C, Verhofstede C, et al (1989) The subcellular localization of the neu protein in human normal and neoplastic cells. Int J Cancer 44:969–974PubMedGoogle Scholar
  10. 10.
    Dubsky PC, Gnant MFX, Taucher S, Roka S, Kandioler D, Pichler-Gebhard B, et al (2002) Young age as an independent adverse prognostic factor in premenopausal patients with breast cancer. Clin Breast Cancer 3:65–72PubMedGoogle Scholar
  11. 11.
    Elledge RM, Ciocca DR, Langone G, McGuire WL (1993) Estrogen receptor, progesterone receptor, and HER-2/neu protein in breast cancers from pregnant patients. Cancer 71:2499–2506PubMedGoogle Scholar
  12. 12.
    Elston CW, Ellis I (1993) Method for grading breast cancer. J Clin Pathol 46:189–190Google Scholar
  13. 13.
    Ewan KB, Shyamala G, Ravani SA, Tang Y, Akhurst R, Wakefield L, et al (2002) Latent transforming growth factor-beta activation in mammary gland: regulation by ovarian hormones affects ductal and alveolar proliferation. Am J Pathol 160:2081–2093PubMedGoogle Scholar
  14. 14.
    Gelber S, Coates AS, Goldhirsch A, Castiglione-Gertsch M, Marini G, Lindtner J, et al (2001) Effect of pregnancy on overall survival after the diagnosis of early-stage breast cancer. J Clin Oncol 19:1671–1675PubMedGoogle Scholar
  15. 15.
    Guinee VF, Olsson H, Moller T, Hess KR, Taylor SH, Fahey T, et al (1994) Effect of pregnancy on prognosis for young women with breast cancer. Lancet 343:1587–1589PubMedGoogle Scholar
  16. 16.
    Hansen S, Naess A (1999) Cancer in Norway 1996. In: Cancer Registry Of Norway. Cancer Registry of Norway, OsloGoogle Scholar
  17. 17.
    Hansen S, Langballe EM, Norstein J, Naess A (2002) Cancer in Norway 1999. In: Cancer Registry of Norway. Cancer Registry of Norway, OsloGoogle Scholar
  18. 18.
    Holland R, Connolly JL, Gelman R, Mravunac M, Hendriks JH, Verbeek AL, et al (1990) The presence of an extensive intraductal component following a limited excision correlates with prominent residual disease in the remainder of the breast. J Clin Oncol 8:113–118PubMedGoogle Scholar
  19. 19.
    Host H, Lund E (1986) Age as a prognostic factor in breast cancer. Cancer 57:2217–2221PubMedGoogle Scholar
  20. 20.
    Ishida T, Yokoe T, Kasumi F, Sakamoto G, Makita M, Tominaga T, et al (1992) Clinicopathologic characteristics and prognosis of breast cancer patients associated with pregnancy and lactation: analysis of case-control study in Japan. Jpn J Cancer Res 83:1143–1149PubMedGoogle Scholar
  21. 21.
    Jacquemier J, Kurtz JM, Amalric R, Brandone H, Ayme Y, Spitalier JM (1990) An assessment of extensive intraductal component as a risk factor for local recurrence after breast-conserving therapy. Br J Cancer 61:873–876PubMedGoogle Scholar
  22. 22.
    Jmor S, Al-Sayer H, Heys S, Payne S, Miller I, Ah-See AK, et al (2002) Breast cancer in women aged 35 and under: prognosis and survival. J R Coll Surg Edinb 47:693–699PubMedGoogle Scholar
  23. 23.
    Karesen R, Jacobsen U, Sauer T, Skaane P (1999) A prospective registration of diagnosis and treatment of breast tumors at the Ulleval hospital 1988–1995 (in Norwegian). Tidsskr Nor Laegeforen 119:3562–3566PubMedGoogle Scholar
  24. 24.
    Kollias J, Elston CW, Ellis IO, Robertson JF, Blamey RW (1997) Early-onset breast cancer—histopathological and prognostic considerations. Br J Cancer 75:1318–1323PubMedGoogle Scholar
  25. 25.
    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 315:851–855PubMedGoogle Scholar
  26. 26.
    Kroman N, Jensen MB, Wohlfahrt J, Mouridsen HT, Andersen PK, Melbye M (2000) Factors influencing the effect of age on prognosis in breast cancer: population based study. BMJ 320:474–478CrossRefPubMedGoogle Scholar
  27. 27.
    Kuerer HM, Cunningham JD, Brower ST, Tartter PI (1997) Breast carcinoma associated with pregnancy and lactation. Surg Oncol 6:93–98CrossRefPubMedGoogle Scholar
  28. 28.
    Lethaby AE, O'Neill MA, Mason BH, Holdaway IM, Harvey VJ (1996) Overall survival from breast cancer in women pregnant or lactating at or after diagnosis. Auckland Breast Cancer Study Group. Int J Cancer 67:751–755CrossRefPubMedGoogle Scholar
  29. 29.
    Nixon AJ, Neuberg D, Hayes DF, Gelman R, Connolly JL, Schnitt S, et al (1994) Relationship of patient age to pathologic features of the tumor and prognosis for patients with stage I or II breast cancer. J Clin Oncol 12:888–894PubMedGoogle Scholar
  30. 30.
    Pertschuk LP, Feldman JG, Kim YD, Braithwaite L, Schneider F, Braverman AS, et al (1996) Estrogen receptor immunocytochemistry in paraffin embedded tissues with ER1D5predicts breast cancer endocrine response more accurately than H222Spgamma in frozen sections or cytosol-based ligand-binding assays. Cancer 77:2514–2519PubMedGoogle Scholar
  31. 31.
    Petrek JA (1991) Pregnancy-associated breast cancer. Semin Surg Oncol 7:306–310PubMedGoogle Scholar
  32. 32.
    Petrek JA, Dukoff R, Rogatko A (1991) Prognosis of pregnancy-associated breast cancer. Cancer 67:869–872PubMedGoogle Scholar
  33. 33.
    Ridolfi RL, Jamehdor MR, Arber JM (2000) HER-2/neu testing in breast carcinoma: a combined immunohistochemical and fluorescence in situ hybridization approach. Mod Pathol 13:866–873PubMedGoogle Scholar
  34. 34.
    Sankila R, Heinavaara S, Hakulinen T (1994) Survival of breast cancer patients after subsequent term pregnancy: "healthy mother effect". Am J Obstet Gynecol 170:818–823PubMedGoogle Scholar
  35. 35.
    Schnitt SJ, Connolly JL, Harris JR, Hellman S, Cohen RB (1984) Pathologic predictors of early local recurrence in Stage I and II breast cancer treated by primary radiation therapy. Cancer 53:1049–1057PubMedGoogle Scholar
  36. 36.
    Styles JM, Harrison S, Gusterson BA, Dean CJ (1990) Rat monoclonal antibodies to the external domain of the product of the C-erbB-2 proto-oncogene. Int J Cancer 45:320–324PubMedGoogle Scholar
  37. 37.
    Suo Z, Emilsen E, Tveit KM, Nesland JM (1998) Type 1 protein tyrosine kinases in benign and malignant breast lesions. Histopathology 33:514–521CrossRefPubMedGoogle Scholar
  38. 38.
    Suo Z, Yang H, Mei Q, Skovlund E, Cui J, Nesland JM (2001) Type 1 protein tyrosine kinases in Chinese breast carcinomas: a clinicopathologic study. Int J Surg Pathol 9:177–187PubMedGoogle Scholar
  39. 39.
    Torry DS, Faulk WP, McIntyre JA (1989) Regulation of immunity to extraembryonic antigens in human pregnancy. Am J Reprod Immunol 21:76–81Google Scholar
  40. 40.
    Tretli S, Kvalheim G, Thoresen S, Host H (1988) Survival of breast cancer patients diagnosed during pregnancy or lactation. Br J Cancer 58:382–384PubMedGoogle Scholar
  41. 41.
    UICC International Union Against Cancer (2002) In: Wittenkind SLH (ed) TNM Atlas, 6th edn. Wiley-Liss, New-York, pp 131–141Google Scholar
  42. 42.
    Velentgas P, Daling JR, Malone KE, Weiss NS, Williams MA, Self SG, et al (1999) Pregnancy after breast carcinoma: outcomes and influence on mortality. Cancer 85:2424–2432CrossRefPubMedGoogle Scholar
  43. 43.
    Von-Schoultz E, Johansson H, Wilking N, Rutqvist LE (1995) Influence of prior and subsequent pregnancy on breast cancer prognosis. J Clin Oncol 13:430–434PubMedGoogle Scholar
  44. 44.
    Wallack CK, Wolf JA, Denes AE, Glasgow G, Kumar B (1983) Gestational carcinoma of the female breast. Curr Probl Cancer 7:1–58Google Scholar
  45. 45.
    Woo JC, Yu T, Hurd TC (2003) Breast cancer in pregnancy. A literature review. Arch Surg 138:91–98PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • W. Reed
    • 1
  • E. Hannisdal
    • 2
  • E. Skovlund
    • 3
  • S. Thoresen
    • 4
  • P. Lilleng
    • 5
  • J. M. Nesland
    • 1
  1. 1.Department of PathologyThe Norwegian Radium Hospital, University of OsloOsloNorway
  2. 2.Health NorthBodøNorway
  3. 3.Section of Medical StatisticsUniversity of OsloNorway
  4. 4.The Norwegian Cancer RegistryOsloNorway
  5. 5.Institute of GadeHaukeland HospitalBergenNorway

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