Advertisement

Breast Cancer Research and Treatment

, Volume 137, Issue 1, pp 297–305 | Cite as

Placental weight and mortality in premenopausal breast cancer by tumor characteristics

  • Mohammad Hossein Hajiebrahimi
  • Shahram Bahmanyar
  • Mats Lambe
  • Jan Adolfsson
  • Tommy Fornander
  • Fredrik Wärnberg
  • Sven Cnattingius
Epidemiology

Abstract

Placental weight may be regarded as an indirect marker of hormone exposures during pregnancy. There is epidemiological evidence that breast cancer mortality in premenopausal women increases with placental weight in the most recent pregnancy. We investigated if this association differs by tumor characteristics, including expression of estrogen and progesterone receptors. In a Swedish population-based cohort, we followed 1,067 women with premenopausal breast cancer diagnosed from 1992 to 2006. Using Cox regression models, we estimated hazard ratios for the association between placental weight and risk of premenopausal breast cancer mortality. In stratified analyses, we estimated mortality risks in subjects with different tumor stages, estrogen receptor (ER) or progesterone receptor (PR) status. Compared with women with placental weight less than 600 g, women with a placental weight between 600 and 699 g were at a 50 % increased risk of mortality, however, not significant change in risk was observed for women with placental weight ≥700 g. Mortality risks associated with higher placental weight were more pronounced among ER and PR breast cancer tumors, where both a placental weight 600–699 g and ≥700 g were associated with a more than doubled mortality risks compared with tumors among women with placental weight less than 600 g. Moreover, stratified analyses for joint receptor status revealed that a consistent increased mortality risk by placental weight was only apparent in women with ER/PR breast cancer. The increased mortality risk in premenopausal breast cancer associated with higher placental weight was most pronounced among ER and PR tumors.

Keywords

Breast cancer Premenopausal Placental weight Estrogen receptor Progesterone receptor 

Notes

Acknowledgments

We are indebted to the members of the steering groups of the Quality registers on Breast Cancer (Stockholm-Gotland and Uppsala-Örebro regions), the National Board of Health and Welfare, and Statistics Sweden for providing data for this investigation. The study was supported by a grant from the Swedish Cancer Society (Grant Number: 2009/843) and by the Cancer Risk Prediction Center (CRiSP), a Linneus Centre (Contract ID 70867902) financed by the Swedish Research Council.

Ethical standards

The study was approved by the research ethics committee of Karolinska Institutet.

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Alsaker MD, Opdahl S, Asvold BO et al (2011) The association of reproductive factors and breastfeeding with long term survival from breast cancer. Breast Cancer Res Treat 130:175–182PubMedCrossRefGoogle Scholar
  2. 2.
    Althuis MD, Fergenbaum JH, Garcia-Closas M et al (2004) Etiology of hormone receptor-defined breast cancer: a systematic review of the literature. Cancer Epidemiol Biomark Prev 13:1558–1568Google Scholar
  3. 3.
    Anderson WF, Chu KC, Chatterjee N et al (2001) Tumor variants by hormone receptor expression in white patients with node-negative breast cancer from the Surveillance, Epidemiology, and End Results database. J Clin Oncol 19:18–27PubMedGoogle Scholar
  4. 4.
    Anderson WF, Chatterjee N, Ershler WB et al (2002) Estrogen receptor breast cancer phenotypes in the Surveillance, Epidemiology, and End Results database. Breast Cancer Res Treat 76:27–36PubMedCrossRefGoogle Scholar
  5. 5.
    Bardou VJ, Arpino G, Elledge RM et al (2003) Progesterone receptor status significantly improves outcome prediction over estrogen receptor status alone for adjuvant endocrine therapy in two large breast cancer databases. J Clin Oncol 21:1973–1979PubMedCrossRefGoogle Scholar
  6. 6.
    Barlow L, Westergren K, Holmberg L et al (2009) The completeness of the Swedish Cancer Register: a sample survey for year 1998. Acta Oncol 48:27–33PubMedCrossRefGoogle Scholar
  7. 7.
    Barnett GC, Shah M, Redman K et al (2008) Risk factors for the incidence of breast cancer: do they affect survival from the disease? J Clin Oncol 26:3310–3316PubMedCrossRefGoogle Scholar
  8. 8.
    Bartlett JM, Brookes CL, Robson T et al (2011) Estrogen receptor and progesterone receptor as predictive biomarkers of response to endocrine therapy: a prospectively powered pathology study in the Tamoxifen and Exemestane Adjuvant Multinational trial. J Clin Oncol 29:1531–1538PubMedCrossRefGoogle Scholar
  9. 9.
    Britton JA, Gammon MD, Schoenberg JB et al (2002) Risk of breast cancer classified by joint estrogen receptor and progesterone receptor status among women 20–44 years of age. Am J Epidemiol 156:507–516PubMedCrossRefGoogle Scholar
  10. 10.
    Butt S, Borgquist S, Garne JP et al (2009) Parity in relation to survival following breast cancer. Eur J Surg Oncol 35:702–708PubMedCrossRefGoogle Scholar
  11. 11.
    Chevallier B, Heintzmann F, Mosseri V et al (1988) Prognostic value of estrogen and progesterone receptors in operable breast cancer. Results of a univariate and multivariate analysis. Cancer 62:2517–2524PubMedCrossRefGoogle Scholar
  12. 12.
    Clark GM, Osborne CK, Mcguire WL (1984) Correlations between estrogen-receptor, progesterone-receptor, and patient characteristics in human-breast cancer. J Clin Oncol 2:1102–1109PubMedGoogle Scholar
  13. 13.
    Cnattingius S, Ericson A, Gunnarskog J et al (1990) A quality study of a medical birth registry. Scand J Soc Med 18:143–148PubMedGoogle Scholar
  14. 14.
    Costa SD, Lange S, Klinga K et al (2002) Factors influencing the prognostic role of oestrogen and progesterone receptor levels in breast cancer—results of the analysis of 670 patients with 11 years of follow-up. Eur J Cancer 38:1329–1334PubMedCrossRefGoogle Scholar
  15. 15.
    Dunnwald LK, Rossing MA, Li CI (2007) Hormone receptor status, tumor characteristics, and prognosis: a prospective cohort of breast cancer patients. Breast Cancer Res 9:R6PubMedCrossRefGoogle Scholar
  16. 16.
    Ferno M, Borg A, Johansson U et al (1990) Estrogen and progesterone-receptor analyses in more than 4000 human breast-cancer samples—a study with special reference to age at diagnosis and stability of analyses. Acta Oncol 29:129–135PubMedCrossRefGoogle Scholar
  17. 17.
    Ferretti G, Felici A, Cognetti F (2007) Pregnancy levels of estrogen and progesterone: the double-edged sword. Cancer Epidemiol Biomarkers Prev 16:634; author reply 634–635Google Scholar
  18. 18.
    Furuhashi N, Tachibana Y, Shinkawa O et al (1984) Simultaneous and serial measurement of serum levels of human placental lactogen, beta-human chorionic gonadotropin and unconjugated estriol levels in pregnant women. Tohoku J Exp Med 144:211–215PubMedCrossRefGoogle Scholar
  19. 19.
    Grann VR, Troxel AB, Zojwalla NJ et al (2005) Hormone receptor status and survival in a population-based cohort of patients with breast carcinoma. Cancer 103:2241–2251PubMedCrossRefGoogle Scholar
  20. 20.
    Green A, Beral V, Moser K (1988) Mortality in women in relation to their childbearing history. Br Med J 297:391–395CrossRefGoogle Scholar
  21. 21.
    Gupta PB, Proia D, Cingoz O et al (2007) Systemic stromal effects of estrogen promote the growth of estrogen receptor-negative cancers. Cancer Res 67:2062–2071PubMedCrossRefGoogle Scholar
  22. 22.
    Huang WY, Newman B, Millikan RC et al (2000) Hormone-related factors and risk of breast cancer in relation to estrogen receptor and progesterone receptor status. Am J Epidemiol 151:703–714PubMedCrossRefGoogle Scholar
  23. 23.
    Hull DF III, Clark GM, Osborne CK et al (1983) Multiple estrogen receptor assays in human breast cancer. Cancer Res 43:413–416PubMedGoogle Scholar
  24. 24.
    Johansson AL, Andersson TM, Hsieh CC et al (2011) Increased mortality in women with breast cancer detected during pregnancy and different periods postpartum. Cancer Epidemiol Biomark Prev 20:1865–1872CrossRefGoogle Scholar
  25. 25.
    Kaijser M, Granath F, Jacobsen G et al (2000) Maternal pregnancy estriol levels in relation to anamnestic and fetal anthropometric data. Epidemiology 11:315–319PubMedCrossRefGoogle Scholar
  26. 26.
    Key TJ (2011) Endogenous oestrogens and breast cancer risk in premenopausal and postmenopausal women. Steroids 76:812–815PubMedCrossRefGoogle Scholar
  27. 27.
    Kiang DT, Kollander R (1987) Breast cancers negative for estrogen receptor but positive for progesterone receptor, a true entity? J Clin Oncol 5:662–666PubMedGoogle Scholar
  28. 28.
    Korzeniowski S, Dyba T (1994) Reproductive history and prognosis in patients with operable breast cancer. Cancer 74:1591–1594PubMedCrossRefGoogle Scholar
  29. 29.
    Kroman N, Mouridsen HT (2003) Prognostic influence of pregnancy before, around, and after diagnosis of breast cancer. Breast 12:516–521PubMedCrossRefGoogle Scholar
  30. 30.
    Kroman N, Wohlfahrt J, Andersen KW et al (1998) Parity, age at first childbirth and the prognosis of primary breast cancer. Br J Cancer 78:1529–1533PubMedCrossRefGoogle Scholar
  31. 31.
    Lambe M, Hsieh C, Trichopoulos D et al (1994) Transient increase in the risk of breast cancer after giving birth. N Engl J Med 331:5–9PubMedCrossRefGoogle Scholar
  32. 32.
    Larfors G, Lambert PC, Lambe M et al (2009) Placental weight and breast cancer survival in young women. Cancer Epidemiol Biomark Prev 18:777–783CrossRefGoogle Scholar
  33. 33.
    Ludvigsson JF, Otterblad-Olausson P, Pettersson BU et al (2009) The Swedish personal identity number: possibilities and pitfalls in healthcare and medical research. Eur J Epidemiol 24:659–667PubMedCrossRefGoogle Scholar
  34. 34.
    Lukanova A, Surcel HM, Lundin E et al (2012) Circulating estrogens and progesterone during primiparous pregnancies and risk of maternal breast cancer. Int J Cancer 130:910–920PubMedCrossRefGoogle Scholar
  35. 35.
    Mason BH, Holdaway IM, Stewart AW et al (1990) Season of tumour detection influences factors predicting survival of patients with breast cancer. Breast Cancer Res Treat 15:27–37PubMedCrossRefGoogle Scholar
  36. 36.
    Mohle-Boetani JC, Grosser S, Whittemore AS et al (1988) Body size, reproductive factors, and breast cancer survival. Prev Med 17:634–642PubMedCrossRefGoogle Scholar
  37. 37.
    Mucci LA, Lagiou P, Tamimi RM et al (2003) Pregnancy estriol, estradiol, progesterone and prolactin in relation to birth weight and other birth size variables (United States). Cancer Causes Control 14:311–318PubMedCrossRefGoogle Scholar
  38. 38.
    Murphy CG, Mallam D, Stein S et al (2012) Current or recent pregnancy is associated with adverse pathologic features but not impaired survival in early breast cancer. Cancer 118:3254–3259PubMedCrossRefGoogle Scholar
  39. 39.
    Olson SH, Zauber AG, Tang J et al (1998) Relation of time since last birth and parity to survival of young women with breast cancer. Epidemiology 9:669–671PubMedCrossRefGoogle Scholar
  40. 40.
    Opdahl S, Alsaker MD, Romundstad PR et al (2012) Placental weight and breast cancer risk in young women: a registry-based cohort study from Norway. Cancer Epidemiol Biomark Prev 21:1060–1065CrossRefGoogle Scholar
  41. 41.
    Osborne CK (1998) Steroid hormone receptors in breast cancer management. Breast Cancer Res Treat 51:227–238PubMedCrossRefGoogle Scholar
  42. 42.
    Peck JD, Hulka BS, Poole C et al (2002) Steroid hormone levels during pregnancy and incidence of maternal breast cancer. Cancer Epidemiol Biomark Prev 11:361–368Google Scholar
  43. 43.
    Phillips KA, Milne RL, Friedlander ML et al (2004) Prognosis of premenopausal breast cancer and childbirth prior to diagnosis. J Clin Oncol 22:699–705PubMedCrossRefGoogle Scholar
  44. 44.
    Potter JD, Cerhan JR, Sellers TA et al (1995) Progesterone and estrogen receptors and mammary neoplasia in the Iowa Women’s Health Study: how many kinds of breast cancer are there? Cancer Epidemiol Biomark Prev 4:319–326Google Scholar
  45. 45.
    Reeves GK, Patterson J, Vessey MP et al (2000) Hormonal and other factors in relation to survival among breast cancer patients. Int J Cancer 89:293–299PubMedCrossRefGoogle Scholar
  46. 46.
    Ries LAG, Eisner MP (2007) Cancer of the female breast. National Cancer Institute, BethesdaGoogle Scholar
  47. 47.
    Rodriguez AO, Chew H, Cress R et al (2008) Evidence of poorer survival in pregnancy-associated breast cancer. Obstet Gynecol 112:71–78PubMedCrossRefGoogle Scholar
  48. 48.
    Rosenberg L, Thalib L, Adami HO et al (2004) Childbirth and breast cancer prognosis. Int J Cancer 111:772–776PubMedCrossRefGoogle Scholar
  49. 49.
    Rosenberg J, Chia YL, Plevritis S (2005) The effect of age, race, tumor size, tumor grade, and disease stage on invasive ductal breast cancer survival in the U.S. SEER database. Breast Cancer Res Treat 89:47–54PubMedCrossRefGoogle Scholar
  50. 50.
    Schouten LJ, Hupperets PS, Jager JJ et al (1997) Prognostic significance of etiological risk factors in early breast cancer. Breast Cancer Res Treat 43:217–223PubMedCrossRefGoogle Scholar
  51. 51.
    Sidoni A, Cavaliere A, Bellezza G et al (2003) Breast cancer in young women: clinicopathological features and biological specificity. Breast 12:247–250PubMedCrossRefGoogle Scholar
  52. 52.
    Sobin LH, Gospodarowicz MK, Wittekind C (2009) TNM classification of malignant tumours, 7th edn. Wiley-Blackwell, Hoboken, NJGoogle Scholar
  53. 53.
    Soerjomataram I, Louwman MW, Ribot JG et al (2008) An overview of prognostic factors for long-term survivors of breast cancer. Breast Cancer Res Treat 107:309–330PubMedCrossRefGoogle Scholar
  54. 54.
    Thorpe SM (1988) Estrogen and progesterone receptor determinations in breast cancer. Technology, biology and clinical significance. Acta Oncol 27:1–19PubMedCrossRefGoogle Scholar
  55. 55.
    Wenger CR, Beardslee S, Owens MA et al (1993) DNA-ploidy, S-phase, and steroid-receptors in more than 127,000 breast-cancer patients. Breast Cancer Res Treat 28:9–20PubMedCrossRefGoogle Scholar
  56. 56.
    Wittliff JL (1984) Steroid-hormone receptors in breast cancer. Cancer 53:630–643PubMedCrossRefGoogle Scholar
  57. 57.
    Yasui Y, Potter JD (1999) The shape of age-incidence curves of female breast cancer by hormone-receptor status. Cancer Causes Control 10:431–437PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Mohammad Hossein Hajiebrahimi
    • 1
    • 8
  • Shahram Bahmanyar
    • 1
    • 2
    • 8
  • Mats Lambe
    • 3
    • 4
  • Jan Adolfsson
    • 5
  • Tommy Fornander
    • 6
  • Fredrik Wärnberg
    • 7
  • Sven Cnattingius
    • 1
  1. 1.Clinical Epidemiology Unit, Department of MedicineKarolinska InstitutetStockholmSweden
  2. 2.Center for Pharmacoepidemiology, Department of MedicineKarolinska InstitutetStockholmSweden
  3. 3.Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
  4. 4.Regional Cancer CenterUppsalaSweden
  5. 5.Department of Clinical Science, Intervention and TechnologyKarolinska InstitutetStockholmSweden
  6. 6.Department of Oncology-PathologyKarolinska InstitutetStockholmSweden
  7. 7.Department of Surgical ScienceUppsala UniversityUppsalaSweden
  8. 8.Faculty of Public HealthGolestan University of Medical SciencesGorganIran

Personalised recommendations