Abstract
Survival in relation to endocrine or reproductive factors has rarely been studied since the focus of most studies has been on the risk of breast cancer. In this study we analysed the effect of multiple birth compared to single births on breast cancer survival. A population based cohort of 30619 women born after 1935 and diagnosed with primary breast cancer, between 1958 and 1998, was generated by linking a number of Swedish registries including Swedish Cancer Registry, Cause of Death Registry, Swedish Generation Registry and the Registry of Population and Population changes. Then we quantified the association between singleton and multiple births to breast cancer specific fatality using the Cox proportional hazards model. We found the singleton and multiple births were associated with increased fatality if breast cancer was diagnosed within 5 years of childbirth, this effect dying out to nil at 5 years after childbirth. Thereafter there was a protective effect on survival with time. Although childbirth is known to decrease breast cancer risk, this study demonstrates that a survival disadvantage exists for breast cancer diagnosed within the first 5 years of singleton and multiple births. It is concluded that breast cancer diagnosed within 5 years of childbirth, particularly if this or prior pregnancies have been multiple, should be regarded as a negative prognostic factor and considered in counselling and treatment of these patients.
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Reference
S Hankinson D. Hunter (2002) Breast cancer HO Adami D Hunter D Trichopoulos (Eds) Textbook of Cancer Epidemiology Oxford University Press New York 301–339
HO Adami LB Signorello D Trichopoulos (1998) ArticleTitleTowards an understanding of breast cancer etiology Semin Cancer Biol 8 255–262 Occurrence Handle10.1006/scbi.1998.0077 Occurrence Handle9870032
KE Innes TE Byers (2004) ArticleTitleFirst pregnancy characteristics and subsequent breast cancer risk among young women Int J Cancer 112 306–311 Occurrence Handle10.1002/ijc.20402 Occurrence Handle15352044
JR Palmer LA Wise NJ Horton LL Adams-Campbell L Rosenberg (2003) ArticleTitleDual effect of parity on breast cancer risk in African-American women J Natl Cancer Inst 95 478–483 Occurrence Handle12644541
Q Liu J Wuu M Lambe SF Hsieh A Ekbom CC Hsieh (2002) ArticleTitleTransient increase in breast cancer risk after giving birth: postpartum period with the highest risk (Sweden) Cancer Causes Control 13 299–305 Occurrence Handle10.1023/A:1015287208222 Occurrence Handle12074499
M Lambe C Hsieh D Trichopoulos A Ekbom M Pavia HO Adami (1994) ArticleTitleTransient increase in the risk of breast cancer after giving birth N Engl J Med 331 5–9 Occurrence Handle10.1056/NEJM199407073310102 Occurrence Handle8202106
J Wohlfahrt JH Olsen M Melby (2002) ArticleTitleBreast cancer risk after childbirth in young women with family history (Denmark) Cancer Causes Control 13 169–174 Occurrence Handle10.1023/A:1014345903347 Occurrence Handle11936823
J Wohlfahrt M Melbye (1999) ArticleTitleMaternal risk of breast cancer and birth characteristics of offspring by time since birth Epidemiology 10 441–444 Occurrence Handle10.1097/00001648-199907000-00014 Occurrence Handle10401881
CC Hsieh M Goldman M Pavia A Ekbom E Petridou HO Adami et al. (1993) ArticleTitleBreast cancer risk in mothers of multiple births Int J Cancer 54 81–84 Occurrence Handle8478150
J Russo IH Russo (1997) ArticleTitleDifferentiation and breast cancer Medicina (B Aires) 57 IssueIDSuppl 2 81–91
L Rosenberg L Thalib HO Adami P Hall (2004) ArticleTitleChildbirth and breast cancer prognosis Int J Cancer 111 772–776 Occurrence Handle10.1002/ijc.20323 Occurrence Handle15252849
SH Olson AG Zauber J Tang S Harlap (1998) ArticleTitleRelation of time since last birth and parity to survival of young women with breast cancer Epidemiology 9 669–671 Occurrence Handle10.1097/00001648-199811000-00015 Occurrence Handle9799180
N Kroman J Wohlfahrt KW Andersen HT Mouridsen T Westergaard M Melbye (1998) ArticleTitleParity, age at first childbirth and the prognosis of primary breast cancer Br J Cancer 78 1529–1533 Occurrence Handle9836489
JR Daling KE Malone DR Doody BO Anderson PL Porter (2002) ArticleTitleThe relation of reproductive factors to mortality from breast cancer Cancer Epidemiol Biomarkers Prev 11 235–241 Occurrence Handle11895871
R Askling (2001) Epidemiological studies of host susceptibility in malignant lymphomas and colorectal cancer Department of Medical Epidemiology, Karolinska Institute, PhD Thesis Stockholm
Anon. Cancer incidence in Sweden 1998. Stockholm Centre for Epidemiology 2000
J Garne K Aspergen T Moller (1995) ArticleTitleValidity of breast cancer registration from one hospital into the Swedish National Cancer Registry 1971--1991 Acta Oncol 34 391–395 Occurrence Handle7779428
VF Guinee H Olsson T Moller KR Hess SH Taylor T Fahey et al. (1994) ArticleTitleEffect of pregnancy on prognosis for young women with breast cancer Lancet 343 1587–1589 Occurrence Handle10.1016/S0140-6736(94)93054-6 Occurrence Handle7911917
D Cox (1972) ArticleTitleRegression models and life tables J Royal Stat Soc 34 182–202
HA Verheul HJ Coelingh-Bennink P Kenemans WJ Atsma CW Burger JA Eden et al. (2000) ArticleTitleEffects of estrogens and hormone replacement therapy on breast cancer risk and on efficacy of breast cancer therapies Maturitas 36 1–17 Occurrence Handle10.1016/S0378-5122(00)00150-X Occurrence Handle10989237
Anonymous. Breast cancer, hormone replacement therapy: collaborative reanalysis of data from 51 epidemiological studies of 52,705 women with breast cancer and 108,411 women without breast cancer. 1997. Collaborative Group on Hormonal Factors in Breast Cancer. Lancet 350; 1047--1059
PI Tartter C Gajdos S Rosenbaum Smith A Estabrook AW Rademaker (2002) ArticleTitleThe prognostic significance of Gail model risk factors for women with breast cancer Am J Surg 184 11–15 Occurrence Handle10.1016/S0002-9610(02)00885-1 Occurrence Handle12135711
SE Weiss PI Tartter S Ahmed ST Brower C Brusco K Bossolt et al. (1995) ArticleTitleEthnic differences in risk and prognostic factors for breast cancer Cancer 76 268–274 Occurrence Handle8625102
M Lambe C Hsieh S Tsaih A Ekbom HO Adami D Trichopoulos (1996) ArticleTitleMaternal risk of breast cancer following multiple births: a nationwide study in Sweden Cancer Causes Control 7 533–538 Occurrence Handle10.1007/BF00051886 Occurrence Handle8877051
N Kroman J Wohlfahrt KW Andersen HT Mouridsen T Westergaard M Melbye (1997) ArticleTitleTime since childbirth and prognosis in primary breast cancer: population based study Br Med J 315 851–855
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Thalib, L., Doi, S.A. & Hall, P. Multiple births and breast cancer prognosis: A population based study. Eur J Epidemiol 20, 613–617 (2005). https://doi.org/10.1007/s10654-005-5530-6
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DOI: https://doi.org/10.1007/s10654-005-5530-6