Abstract
Reproductive factors that influence breast cancer risk may also have an impact on survival, once the disease is diagnosed. In this study, 2,640 women were diagnosed with invasive breast cancer during follow-up after a breast cancer screening that took place in 1956–1959. Survival was assessed in relation to age at menarche, age at first birth, parity, history of breastfeeding, age at menopause, and the effect of BMI was assessed in a subset of patients. It is a special feature that the patients of this study have not been subjected to organized mammography screening and their use of exogenous hormones has been negligible. By the end of follow-up (2008), 2,301 (87%) of the patients had died and 1,022 (44%) of the deaths were caused by breast cancer. Breast cancer survival was not associated with age at menarche, parity or time since last birth, but survival was consistently poorer with increasing age at first birth (P for trend 0.03): comparing a first birth after 35 years with 25–29 years, the hazard ratio was 1.32 (95% CI 1.02–1.72). There was no evidence for a dose-related effect of breastfeeding, but BMI measured many years prior to diagnosis was inversely associated with survival (P for trend <0.01). The main finding was that reproductive factors, including breastfeeding, appear to have little influence on the survival of breast cancer patients. Age at first birth may be an exception to this, since we found a gradually poorer survival with increasing age at first birth. We also found that overweight and obesity, as measured many years prior to diagnosis, were associated with poorer survival.
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References
Kelsey JL, Gammon MD (1991) The epidemiology of breast cancer. CA Cancer J Clin 41:146–165
Schouten LJ, Hupperets PS, Jager JJ, Volovics L, Wils JA, Verbeek AL et al (1997) Prognostic significance of etiological risk factors in early breast cancer. Breast Cancer Res Treat 43:217–223
Rosenberg L, Thalib L, Adami HO, Hall P (2004) Childbirth and breast cancer prognosis. Int J Cancer 111:772–776. doi:10.1002/ijc.20323
Barnett GC, Shah M, Redman K, Easton DF, Ponder BA, Pharoah PD (2008) Risk factors for the incidence of breast cancer: do they affect survival from the disease? J Clin Oncol 26:3310–3316
Butt S, Borgquist S, Garne JP, Landberg G, Tengrup I, Olsson A et al (2009) Parity in relation to survival following breast cancer. Eur J Surg Oncol 35:702–708
Reeves GK, Patterson J, Vessey MP, Yeates D, Jones L (2000) Hormonal and other factors in relation to survival among breast cancer patients. Int J Cancer 89:293–299. doi:10.1002/1097-0215(20000520)89
Kroman N, Wohlfahrt J, Andersen KW, Mouridsen HT, Westergaard T, Melbye M (1998) Parity, age at first childbirth and the prognosis of primary breast cancer. Br J Cancer 78:1529–1533
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 315:851–855
Phillips KA, Milne RL, Friedlander ML, Jenkins MA, McCredie MR, Giles GG et al (2004) Prognosis of premenopausal breast cancer and childbirth prior to diagnosis. J Clin Oncol 22:699–705. doi:10.1200/JCO.2004.07.062
Phillips KA, Milne RL, West DW, Goodwin PJ, Giles GG, Chang ET et al (2009) Prediagnosis reproductive factors and all-cause mortality for women with breast cancer in the breast cancer family registry. Cancer Epidemiol Biomarkers Prev 18:1792–1797
Trivers KF, Gammon MD, Abrahamson PE, Lund MJ, Flagg EW, Kaufman JS et al (2007) Association between reproductive factors and breast cancer survival in younger women. Breast Cancer Res Treat 103:93–102. doi:10.1007/s10549-006-9346-1
Orgeas CC, Hall P, Rosenberg LU, Czene K (2008) The influence of menstrual risk factors on tumor characteristics and survival in postmenopausal breast cancer. Breast Cancer Res 10:R107
Yang L, Jacobsen KH (2008) A systematic review of the association between breastfeeding and breast cancer. J Womens Health 17:1635–1645. doi:10.1089/jwh.2008.0917
Collaborative Group on Hormonal Factors in Breast Cancer (2002) Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50302 women with breast cancer and 96973 women without the disease. Lancet 360:187–195
Whiteman MK, Hillis SD, Curtis KM, McDonald JA, Wingo PA, Marchbanks PA (2004) Reproductive history and mortality after breast cancer diagnosis. Obstet Gynecol 104:146–154. doi:10.1097/01.AOG.0000128173.01611.ff
Nagtegaal ID, Allgood PC, Duffy SW, Kearins O, Sullivan EO, Tappenden N et al (2010) Prognosis and pathology of screen-detected carcinomas: how different are they? Cancer. doi:10.1002/cncr.25613
Narod SA (2011) Age of diagnosis, tumor size, and survival after breast cancer: implications for mammographic screening. Breast Cancer Res Treat. doi:10.1007/s10549-010-1318-9
Antoine C, Liebens F, Carly B, Pastijn A, Rozenberg S (2004) Influence of HRT on prognostic factors for breast cancer: a systematic review after the Women’s Health Initiative trial. Hum Reprod 19:741–756. doi:10.1093/humrep/deh112
Bergsjø P (1984) Drug consumption in Norway. In: Øydvin K (ed) Comments on the use of oestrogens 1979–83. Norsk medisinaldepot, Oslo, pp 114–115
Kalager M, Haldorsen T, Bretthauer M, Hoff G, Thoresen SO, Adami HO (2009) Improved breast cancer survival following introduction of an organized mammography screening program among both screened and unscreened women: a population-based cohort study. Breast Cancer Res 11:R44
Kvale G, Heuch I, Eide GE (1987) A prospective study of reproductive factors and breast cancer. I. Parity. Am J Epidemiol 126:831–841
Tretli S (1989) Height and weight in relation to breast cancer morbidity and mortality. A prospective study of 570,000 women in Norway. Int J Cancer 44:23–30
Chlebowski RT, Aiello E, McTiernan A (2002) Weight loss in breast cancer patient management. J Clin Oncol 20:1128–1143
Majed B, Moreau T, Senouci K, Salmon RJ, Fourquet A, Asselain B (2008) Is obesity an independent prognosis factor in woman breast cancer? Breast Cancer Res Treat 111:329–342. doi:10.1007/s10549-007-9785-3
Butt S, Borgquist S, Anagnostaki L, Landberg G, Manjer J (2009) Parity and age at first childbirth in relation to the risk of different breast cancer subgroups. Int J Cancer 125:1926–1934. doi:10.1002/ijc.24494
Russo J, Moral R, Balogh GA, Mailo D, Russo IH (2005) The protective role of pregnancy in breast cancer. Breast Cancer Res 7:131–142
Russo J, Balogh GA, Russo IH (2008) Full-term pregnancy induces a specific genomic signature in the human breast. Cancer Epidemiol Biomarkers Prev 17:51–66
Jernstrom H, Lubinski J, Lynch HT, Ghadirian P, Neuhausen S, Isaacs C et al (2004) Breast-feeding and the risk of breast cancer in BRCA1 and BRCA2 mutation carriers. J Natl Cancer Inst 96:1094–1098. doi:10.1093/jnci/djh211
Bernstein L (2002) Epidemiology of endocrine-related risk factors for breast cancer. J Mammary Gland Biol Neoplasia 7:3–15
Lonning PE, Helle SI, Johannessen DC, Ekse D, Adlercreutz H (1996) Influence of plasma estrogen levels on the length of the disease-free interval in postmenopausal women with breast cancer. Breast Cancer Res Treat 39:335–341
Paterson AH, Zuck VP, Szafran O, Lees AW, Hanson J (1982) Influence and significance of certain prognostic factors on survival in breast cancer. Eur J Cancer Clin Oncol 18:937–943
Knight WA, Livingston RB, Gregory EJ, McGuire WL (1977) Estrogen receptor as an independent prognostic factor for early recurrence in breast cancer. Cancer Res 37:4669–4671
Ma H, Bernstein L, Pike MC, Ursin G (2006) Reproductive factors and breast cancer risk according to joint estrogen and progesterone receptor status: a meta-analysis of epidemiological studies. Breast Cancer Res 8:R43
Althuis MD, Fergenbaum JH, Garcia-Closas M, Brinton LA, Madigan MP, Sherman ME (2004) Etiology of hormone receptor-defined breast cancer: a systematic review of the literature. Cancer Epidemiol Biomarkers Prev 13:1558–1568
Chlebowski RT, Chen Z, Anderson GL, Rohan T, Aragaki A, Lane D et al (2005) Ethnicity and breast cancer: factors influencing differences in incidence and outcome. J Natl Cancer Inst 97:439–448
Phipps AI, Chlebowski RT, Prentice R, McTiernan A, Wactawski-Wende J, Kuller LH et al (2011) Reproductive history and oral contraceptive use in relation to risk of triple-negative breast cancer. J Natl Cancer Inst 103:470–477
Kwan ML, Kushi LH, Weltzien E, Maring B, Kutner SE, Fulton RS et al (2009) Epidemiology of breast cancer subtypes in two prospective cohort studies of breast cancer survivors. Breast Cancer Res 11:R31
Trivers KF, Lund MJ, Porter PL, Liff JM, Flagg EW, Coates RJ et al (2009) The epidemiology of triple-negative breast cancer, including race. Cancer Causes Control 20:1071–1082. doi:10.1007/s10552-009-9331-1
Millikan RC, Newman B, Tse CK, Moorman PG, Conway K, Dressler LG et al (2008) Epidemiology of basal-like breast cancer. Breast Cancer Res Treat 109:123–139. doi:10.1007/s10549-007-9632-6
Yang XR, Chang-Claude J, Goode EL, Couch FJ, Nevanlinna H, Milne RL et al (2011) Associations of breast cancer risk factors with tumor subtypes: a pooled analysis from the breast cancer association consortium studies. J Natl Cancer Inst 103:250–263
Perou CM, Sorlie T, Eisen MB, van de Rijn M, Jeffrey SS, Rees CA et al (2000) Molecular portraits of human breast tumours. Nature 406:747–752. doi:10.1038/35021093
Blows FM, Driver KE, Schmidt MK, Broeks A, van Leeuwen FE, Wesseling J et al (2010) Subtyping of breast cancer by immunohistochemistry to investigate a relationship between subtype and short and long term survival: a collaborative analysis of data for 10,159 cases from 12 studies. PLoS Med 7:e1000279. doi:10.1371/journal.pmed.1000279
Larsen IK, Smastuen M, Johannesen TB, Langmark F, Parkin DM, Bray F et al (2009) Data quality at the Cancer Registry of Norway: an overview of comparability, completeness, validity and timeliness. Eur J Cancer 45:1218–1231
Rothman K, Greenland S, Lash T (2008) Modern epidemiology, 3rd edn. Lippincott Williams & Wilkins, Philadelphia
Kaufman JS, Maclehose RF, Kaufman S (2004) A further critique of the analytic strategy of adjusting for covariates to identify biologic mediation. Epidemiol Perspect Innov 1:4
Acknowledgments
M.D.K.A. is a research fellow financed by the Norwegian University of Science and Technology (NTNU). The study was supported by a grant from the Norwegian Research Council. We want to thank the Cancer Registry of Norway for providing the data, the Norwegian Cancer Society for carrying out the original study, and the attending women for participating in the study.
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Alsaker, M.D.K., Opdahl, S., Åsvold, B.O. et al. The association of reproductive factors and breastfeeding with long term survival from breast cancer. Breast Cancer Res Treat 130, 175–182 (2011). https://doi.org/10.1007/s10549-011-1566-3
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DOI: https://doi.org/10.1007/s10549-011-1566-3