Breast cancer risk after recent childbirth: A pooled analysis of 15 prospective studies

Hazel B. Nichols, Minouk J. Schoemaker, Jianwen Cai, Jiawei Xu, Lauren B. Wright, Mark N. Brook, Michael E. Jones, Hans Olov Adami, Laura Baglietto, Kimberly A. Bertrand, William J. Blot, Marie Christine Boutron-Ruault, Miren Dorronsoro, Laure Dossus, A. Heather Eliassen, Graham G. Giles, Inger T. Gram, Susan E. Hankinson, Judy Hoffman-Bolton, Rudolf KaaksTimothy J. Key, Cari M. Kitahara, Susanna C. Larsson, Martha Linet, Melissa A. Merritt, Roger L. Milne, Valeria Pala, Julie R. Palmer, Petra H. Peeters, Elio Riboli, Malin Sund, Rulla M. Tamimi, Anne Tjønneland, Antonia Trichopoulou, Giske Ursin, Lars Vatten, Kala Visvanathan, Elisabete Weiderpass, Alicja Wolk, Wei Zheng, Clarice R. Weinberg, Anthony J. Swerdlow, Dale P. Sandler

Research output: Contribution to journalArticle

Abstract

Background: Parity is widely recognized as protective for breast cancer, but breast cancer risk may be increased shortly after childbirth. Whether this risk varies with breastfeeding, family history of breast cancer, or specific tumor subtype has rarely been evaluated. Objective: To characterize breast cancer risk in relation to recent childbirth. Design: Pooled analysis of individual-level data from 15 prospective cohort studies. Setting: The international Premenopausal Breast Cancer Collaborative Group. Participants: Women younger than 55 years. Measurements: During 9.6 million person-years of follow-up, 18 826 incident cases of breast cancer were diagnosed. Hazard ratios (HRs) and 95% CIs for breast cancer were calculated using Cox proportional hazards regression. Results: Compared with nulliparous women, parous women had an HR for breast cancer that peaked about 5 years after birth (HR, 1.80 [95% CI, 1.63 to 1.99]) before decreasing to 0.77 (CI, 0.67 to 0.88) after 34 years. The association crossed over from positive to negative about 24 years after birth. The overall pattern was driven by estrogen receptor (ER)-positive breast cancer; no crossover was seen for ER-negative cancer. Increases in breast cancer risk after childbirth were pronounced when combined with a family history of breast cancer and were greater for women who were older at first birth or who had more births. Breastfeeding did not modify overall risk patterns. Limitations: Breast cancer diagnoses during pregnancy were not uniformly distinguishable from early postpartum diagnoses. Data on human epidermal growth factor receptor 2 (HER2) oncogene overexpression were limited. Conclusion: Compared with nulliparous women, parous women have an increased risk for breast cancer for more than 20 years after childbirth. Health care providers should consider recent childbirth a risk factor for breast cancer in young women.

Original languageEnglish (US)
Pages (from-to)22-30
Number of pages9
JournalAnnals of Internal Medicine
Volume170
Issue number1
DOIs
StatePublished - Jan 1 2019

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Parturition
Prospective Studies
Breast Neoplasms
Breast Feeding
Estrogen Receptors
Birth Order
Parity
Oncogenes
Health Personnel
Postpartum Period
Early Diagnosis
Neoplasms
Cohort Studies
Pregnancy

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Nichols, H. B., Schoemaker, M. J., Cai, J., Xu, J., Wright, L. B., Brook, M. N., ... Sandler, D. P. (2019). Breast cancer risk after recent childbirth: A pooled analysis of 15 prospective studies. Annals of Internal Medicine, 170(1), 22-30. https://doi.org/10.7326/M18-1323

Breast cancer risk after recent childbirth : A pooled analysis of 15 prospective studies. / Nichols, Hazel B.; Schoemaker, Minouk J.; Cai, Jianwen; Xu, Jiawei; Wright, Lauren B.; Brook, Mark N.; Jones, Michael E.; Adami, Hans Olov; Baglietto, Laura; Bertrand, Kimberly A.; Blot, William J.; Boutron-Ruault, Marie Christine; Dorronsoro, Miren; Dossus, Laure; Eliassen, A. Heather; Giles, Graham G.; Gram, Inger T.; Hankinson, Susan E.; Hoffman-Bolton, Judy; Kaaks, Rudolf; Key, Timothy J.; Kitahara, Cari M.; Larsson, Susanna C.; Linet, Martha; Merritt, Melissa A.; Milne, Roger L.; Pala, Valeria; Palmer, Julie R.; Peeters, Petra H.; Riboli, Elio; Sund, Malin; Tamimi, Rulla M.; Tjønneland, Anne; Trichopoulou, Antonia; Ursin, Giske; Vatten, Lars; Visvanathan, Kala; Weiderpass, Elisabete; Wolk, Alicja; Zheng, Wei; Weinberg, Clarice R.; Swerdlow, Anthony J.; Sandler, Dale P.

In: Annals of Internal Medicine, Vol. 170, No. 1, 01.01.2019, p. 22-30.

Research output: Contribution to journalArticle

Nichols, HB, Schoemaker, MJ, Cai, J, Xu, J, Wright, LB, Brook, MN, Jones, ME, Adami, HO, Baglietto, L, Bertrand, KA, Blot, WJ, Boutron-Ruault, MC, Dorronsoro, M, Dossus, L, Eliassen, AH, Giles, GG, Gram, IT, Hankinson, SE, Hoffman-Bolton, J, Kaaks, R, Key, TJ, Kitahara, CM, Larsson, SC, Linet, M, Merritt, MA, Milne, RL, Pala, V, Palmer, JR, Peeters, PH, Riboli, E, Sund, M, Tamimi, RM, Tjønneland, A, Trichopoulou, A, Ursin, G, Vatten, L, Visvanathan, K, Weiderpass, E, Wolk, A, Zheng, W, Weinberg, CR, Swerdlow, AJ & Sandler, DP 2019, 'Breast cancer risk after recent childbirth: A pooled analysis of 15 prospective studies', Annals of Internal Medicine, vol. 170, no. 1, pp. 22-30. https://doi.org/10.7326/M18-1323
Nichols, Hazel B. ; Schoemaker, Minouk J. ; Cai, Jianwen ; Xu, Jiawei ; Wright, Lauren B. ; Brook, Mark N. ; Jones, Michael E. ; Adami, Hans Olov ; Baglietto, Laura ; Bertrand, Kimberly A. ; Blot, William J. ; Boutron-Ruault, Marie Christine ; Dorronsoro, Miren ; Dossus, Laure ; Eliassen, A. Heather ; Giles, Graham G. ; Gram, Inger T. ; Hankinson, Susan E. ; Hoffman-Bolton, Judy ; Kaaks, Rudolf ; Key, Timothy J. ; Kitahara, Cari M. ; Larsson, Susanna C. ; Linet, Martha ; Merritt, Melissa A. ; Milne, Roger L. ; Pala, Valeria ; Palmer, Julie R. ; Peeters, Petra H. ; Riboli, Elio ; Sund, Malin ; Tamimi, Rulla M. ; Tjønneland, Anne ; Trichopoulou, Antonia ; Ursin, Giske ; Vatten, Lars ; Visvanathan, Kala ; Weiderpass, Elisabete ; Wolk, Alicja ; Zheng, Wei ; Weinberg, Clarice R. ; Swerdlow, Anthony J. ; Sandler, Dale P. / Breast cancer risk after recent childbirth : A pooled analysis of 15 prospective studies. In: Annals of Internal Medicine. 2019 ; Vol. 170, No. 1. pp. 22-30.
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abstract = "Background: Parity is widely recognized as protective for breast cancer, but breast cancer risk may be increased shortly after childbirth. Whether this risk varies with breastfeeding, family history of breast cancer, or specific tumor subtype has rarely been evaluated. Objective: To characterize breast cancer risk in relation to recent childbirth. Design: Pooled analysis of individual-level data from 15 prospective cohort studies. Setting: The international Premenopausal Breast Cancer Collaborative Group. Participants: Women younger than 55 years. Measurements: During 9.6 million person-years of follow-up, 18 826 incident cases of breast cancer were diagnosed. Hazard ratios (HRs) and 95{\%} CIs for breast cancer were calculated using Cox proportional hazards regression. Results: Compared with nulliparous women, parous women had an HR for breast cancer that peaked about 5 years after birth (HR, 1.80 [95{\%} CI, 1.63 to 1.99]) before decreasing to 0.77 (CI, 0.67 to 0.88) after 34 years. The association crossed over from positive to negative about 24 years after birth. The overall pattern was driven by estrogen receptor (ER)-positive breast cancer; no crossover was seen for ER-negative cancer. Increases in breast cancer risk after childbirth were pronounced when combined with a family history of breast cancer and were greater for women who were older at first birth or who had more births. Breastfeeding did not modify overall risk patterns. Limitations: Breast cancer diagnoses during pregnancy were not uniformly distinguishable from early postpartum diagnoses. Data on human epidermal growth factor receptor 2 (HER2) oncogene overexpression were limited. Conclusion: Compared with nulliparous women, parous women have an increased risk for breast cancer for more than 20 years after childbirth. Health care providers should consider recent childbirth a risk factor for breast cancer in young women.",
author = "Nichols, {Hazel B.} and Schoemaker, {Minouk J.} and Jianwen Cai and Jiawei Xu and Wright, {Lauren B.} and Brook, {Mark N.} and Jones, {Michael E.} and Adami, {Hans Olov} and Laura Baglietto and Bertrand, {Kimberly A.} and Blot, {William J.} and Boutron-Ruault, {Marie Christine} and Miren Dorronsoro and Laure Dossus and Eliassen, {A. Heather} and Giles, {Graham G.} and Gram, {Inger T.} and Hankinson, {Susan E.} and Judy Hoffman-Bolton and Rudolf Kaaks and Key, {Timothy J.} and Kitahara, {Cari M.} and Larsson, {Susanna C.} and Martha Linet and Merritt, {Melissa A.} and Milne, {Roger L.} and Valeria Pala and Palmer, {Julie R.} and Peeters, {Petra H.} and Elio Riboli and Malin Sund and Tamimi, {Rulla M.} and Anne Tj{\o}nneland and Antonia Trichopoulou and Giske Ursin and Lars Vatten and Kala Visvanathan and Elisabete Weiderpass and Alicja Wolk and Wei Zheng and Weinberg, {Clarice R.} and Swerdlow, {Anthony J.} and Sandler, {Dale P.}",
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T1 - Breast cancer risk after recent childbirth

T2 - A pooled analysis of 15 prospective studies

AU - Nichols, Hazel B.

AU - Schoemaker, Minouk J.

AU - Cai, Jianwen

AU - Xu, Jiawei

AU - Wright, Lauren B.

AU - Brook, Mark N.

AU - Jones, Michael E.

AU - Adami, Hans Olov

AU - Baglietto, Laura

AU - Bertrand, Kimberly A.

AU - Blot, William J.

AU - Boutron-Ruault, Marie Christine

AU - Dorronsoro, Miren

AU - Dossus, Laure

AU - Eliassen, A. Heather

AU - Giles, Graham G.

AU - Gram, Inger T.

AU - Hankinson, Susan E.

AU - Hoffman-Bolton, Judy

AU - Kaaks, Rudolf

AU - Key, Timothy J.

AU - Kitahara, Cari M.

AU - Larsson, Susanna C.

AU - Linet, Martha

AU - Merritt, Melissa A.

AU - Milne, Roger L.

AU - Pala, Valeria

AU - Palmer, Julie R.

AU - Peeters, Petra H.

AU - Riboli, Elio

AU - Sund, Malin

AU - Tamimi, Rulla M.

AU - Tjønneland, Anne

AU - Trichopoulou, Antonia

AU - Ursin, Giske

AU - Vatten, Lars

AU - Visvanathan, Kala

AU - Weiderpass, Elisabete

AU - Wolk, Alicja

AU - Zheng, Wei

AU - Weinberg, Clarice R.

AU - Swerdlow, Anthony J.

AU - Sandler, Dale P.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Parity is widely recognized as protective for breast cancer, but breast cancer risk may be increased shortly after childbirth. Whether this risk varies with breastfeeding, family history of breast cancer, or specific tumor subtype has rarely been evaluated. Objective: To characterize breast cancer risk in relation to recent childbirth. Design: Pooled analysis of individual-level data from 15 prospective cohort studies. Setting: The international Premenopausal Breast Cancer Collaborative Group. Participants: Women younger than 55 years. Measurements: During 9.6 million person-years of follow-up, 18 826 incident cases of breast cancer were diagnosed. Hazard ratios (HRs) and 95% CIs for breast cancer were calculated using Cox proportional hazards regression. Results: Compared with nulliparous women, parous women had an HR for breast cancer that peaked about 5 years after birth (HR, 1.80 [95% CI, 1.63 to 1.99]) before decreasing to 0.77 (CI, 0.67 to 0.88) after 34 years. The association crossed over from positive to negative about 24 years after birth. The overall pattern was driven by estrogen receptor (ER)-positive breast cancer; no crossover was seen for ER-negative cancer. Increases in breast cancer risk after childbirth were pronounced when combined with a family history of breast cancer and were greater for women who were older at first birth or who had more births. Breastfeeding did not modify overall risk patterns. Limitations: Breast cancer diagnoses during pregnancy were not uniformly distinguishable from early postpartum diagnoses. Data on human epidermal growth factor receptor 2 (HER2) oncogene overexpression were limited. Conclusion: Compared with nulliparous women, parous women have an increased risk for breast cancer for more than 20 years after childbirth. Health care providers should consider recent childbirth a risk factor for breast cancer in young women.

AB - Background: Parity is widely recognized as protective for breast cancer, but breast cancer risk may be increased shortly after childbirth. Whether this risk varies with breastfeeding, family history of breast cancer, or specific tumor subtype has rarely been evaluated. Objective: To characterize breast cancer risk in relation to recent childbirth. Design: Pooled analysis of individual-level data from 15 prospective cohort studies. Setting: The international Premenopausal Breast Cancer Collaborative Group. Participants: Women younger than 55 years. Measurements: During 9.6 million person-years of follow-up, 18 826 incident cases of breast cancer were diagnosed. Hazard ratios (HRs) and 95% CIs for breast cancer were calculated using Cox proportional hazards regression. Results: Compared with nulliparous women, parous women had an HR for breast cancer that peaked about 5 years after birth (HR, 1.80 [95% CI, 1.63 to 1.99]) before decreasing to 0.77 (CI, 0.67 to 0.88) after 34 years. The association crossed over from positive to negative about 24 years after birth. The overall pattern was driven by estrogen receptor (ER)-positive breast cancer; no crossover was seen for ER-negative cancer. Increases in breast cancer risk after childbirth were pronounced when combined with a family history of breast cancer and were greater for women who were older at first birth or who had more births. Breastfeeding did not modify overall risk patterns. Limitations: Breast cancer diagnoses during pregnancy were not uniformly distinguishable from early postpartum diagnoses. Data on human epidermal growth factor receptor 2 (HER2) oncogene overexpression were limited. Conclusion: Compared with nulliparous women, parous women have an increased risk for breast cancer for more than 20 years after childbirth. Health care providers should consider recent childbirth a risk factor for breast cancer in young women.

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