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Breast cancer treatment patterns by age and time since last pregnancy in the Carolina Breast Cancer Study Phase III

  • Epidemiology
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Abstract

Purpose

To describe breast cancer treatment patterns among premenopausal women by age and time since last pregnancy.

Methods

Data were analyzed from 1179 women diagnosed with premenopausal breast cancer in the Carolina Breast Cancer Study. Of these, 160 had a recent pregnancy (within 5 years of cancer diagnosis). Relative frequency differences (RFDs) and 95% confidence intervals (CIs) were used to compare cancer stage, treatment modality received, treatment initiation delay (> 30 days), and prolonged treatment duration (> 2 to > 8 months depending on the treatment received) by age and recency of pregnancy.

Results

Recently postpartum women were significantly more likely to have stage III disease [RFD (95% CI) 12.2% (3.6%, 20.8%)] and to receive more aggressive treatment compared to nulliparous women. After adjustment for age, race and standard clinical tumor characteristics, recently postpartum women were significantly less likely to have delayed treatment initiation [RFD (95% CI) − 11.2% (− 21.4%, − 1.0%)] and prolonged treatment duration [RFD (95% CI) − 17.5% (− 28.0%, − 7.1%)] and were more likely to have mastectomy [RFD (95% CI) 14.9% (4.8%, 25.0%)] compared to nulliparous. Similarly, younger women (< 40 years of age) were significantly less likely to experience prolonged treatment duration [RFD (95% CI) − 5.6% (− 11.1%, − 0.0%)] and more likely to undergo mastectomy [RFD (95% CI) 10.6% (5.2%, 16.0%)] compared to the study population as a whole.

Conclusion

These results suggest that recently postpartum and younger women often received prompt and aggressive breast cancer treatment. Higher mortality and recurrence among recently pregnant women are unlikely to be related to undertreatment.

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Data availability

For participant confidentiality and due to ethical restrictions, data are available upon request and are subject to data use agreements and other stipulations. Permission to access data from the Carolina Breast Cancer Study may be obtained online (https://unclineberger.org/cbcs/) or by contacting the authors.

Code availability

Not applicable.

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Acknowledgements

This research was supported by a Grant from UNC Lineberger Comprehensive Cancer Center, which is funded by the University Cancer Research Fund of North Carolina, the Susan G. Komen Foundation (OGUNC1202), the Komen Graduate Training in Disparities Research Grant (GTDR16381071), the National Cancer Institute of the National Institutes of Health (P01CA151135), and the National Cancer Institute Specialized Program of Research Excellence (SPORE) in Breast Cancer (NIH/NCI P50-CA58223). This research recruited participants and/or obtained data with the assistance of Rapid Case Ascertainment, a collaboration between the North Carolina Central Cancer Registry and UNC Lineberger. RCA is supported by a grant from the National Cancer Institute of the National Institutes of Health (P30CA016086). We are grateful to CBCS participants and study staff. We also acknowledge the late Robert C. Millikan, founder of the CBCS Phase III.

Funding

Sanah N. Vohra was supported by the University Cancer Research Fund of North Carolina, the Komen Graduate Training in Disparities Research Grant (GTDR16381071), the Doctoral Degree Advancement Award by the University of North Carolina (UNC) – Initiative for Minority Excellence, and the UNC Cancer Control Education Program (T32CA057726). Melissa A. Troester was supported by the National Cancer Institute of the National Institutes of Health (P01CA151135) and the National Cancer Institute Specialized Program of Research Excellence (SPORE) in Breast Cancer (NIH/NCI P50-CA58223). The Carolina Breast Cancer Study was funded by the University Cancer Research Fund of North Carolina and Susan G. Komen for the Cure (OGUNC1202).

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Authors and Affiliations

  1. Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Sanah N. Vohra, Hazel B. Nichols, Marc A. Emerson, Andrew F. Olshan & Melissa A. Troester

  2. Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Sanah N. Vohra, Hazel B. Nichols, Marc A. Emerson, Andrew F. Olshan & Melissa A. Troester

  3. Division of Hematology/Oncology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Katherine E. Reeder-Hayes

  4. Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Michael I. Love

  5. Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Michael I. Love

  6. Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Melissa A. Troester

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  1. Sanah N. Vohra
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Contributions

SNV involved in conceptualization, data curation, formal analysis, investigation, methodology, writing–original draft, and writing–review and editing. KERH, HBN, MIL, and AFO participated in conceptualization, investigation, methodology, writing–original draft, and writing–review and editing. MAE took part in conceptualization, data curation, and writing–review and editing. MAT involved in conceptualization, funding acquisition, project administration, investigation, formal analysis, methodology, writing–original draft, and writing–review and editing.

Corresponding author

Correspondence to Sanah N. Vohra.

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The authors declare that they have no conflict of interest.

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All study protocols were approved by the Office of Human Research Ethics, Institutional Review Board at the University of North Carolina at Chapel Hill (UNC).

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Written informed consent was obtained from all individual participants included in the study prior to data collection.

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All participants consented to the submission of study results for journal publication.

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Vohra, S.N., Reeder-Hayes, K.E., Nichols, H.B. et al. Breast cancer treatment patterns by age and time since last pregnancy in the Carolina Breast Cancer Study Phase III. Breast Cancer Res Treat 192, 435–445 (2022). https://doi.org/10.1007/s10549-022-06511-9

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