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Prognosis of Premenopausal Breast Cancer and Childbirth Prior to Diagnosis

From the Peter MacCallum Cancer Centre, The University of Melbourne, and The Cancer Council Victoria, Victoria, Australia; Prince of Wales Hospital, New South Wales, Australia; and University of Otago, Dunedin, New Zealand

Address reprint requests to John L. Hopper, PhD, Centre for Genetic Epidemiology, University of Melbourne, Level 2, 723 Swanston St, Carlton, Victoria 3053, Australia; e-mail: j.hopper{at}unimelb.edu.au

PURPOSE: The time interval between last childbirth and subsequent breast cancer diagnosis is emerging as an important prognostic factor for premenopausal women.

PATIENTS AND METHODS: We studied, prospectively, 750 women diagnosed with primary invasive breast cancer before age 45 years who participated in the population-based Australian Breast Cancer Family Study (ABCFS).

RESULTS: Median follow-up time was 4.9 years (range, 0.8 to 10.8 years). Compared with nulliparous women, women who gave birth within 2 years prior to diagnosis were more likely to have axillary node-positive (58% v 41%; P = .01), and estrogen receptor-negative (58% v 39%; P = .005) tumors. The unadjusted hazard ratios for death were 2.3 (95% CI, 1.3 to 3.8; P = .002), 1.7 (95% CI, 1.1 to 2.6; P = .03), and 0.9 (95% CI, 0.6 to 1.5; P = .8) for patients who gave birth less than 2 years, 2 to 5 years, and 5 or more years before diagnosis, respectively. After adjusting for tumor characteristics, these hazard ratios were reduced to 1.9 (95%CI, 1.1 to 3.2; P = .02), 1.3 (95% CI, 0.8 to 2.1; P = .3), and 0.9 (95%CI, 0.5 to 1.4; P = .5). Modeling showed that, compared with nulliparous women, the mortality hazard ratio in parous women was 1.9, decreasing by 8% (95%CI, 4% to 13%; P < .001) for each year between last birth and breast cancer diagnosis.

CONCLUSION: Proximity of last childbirth to subsequent breast cancer diagnosis is a predictor of mortality independent of histopathological tumor characteristics. Clinicians should be aware that women diagnosed with breast cancer within a few years following childbirth may have a worse outcome than that suggested solely by the standard histopathological prognostic factors of their cancer.

This study was specifically supported by the National Health and Medical Research Council of Australia (#145604). The Australian Breast Cancer Family Study was supported by the National Health and Medical Research Council of Australia, the New South Wales Cancer Council, the Victorian Health Promotion Foundation, and the United States National Cancer Institute, National Institutes of Health (under RFA #CA-95-003), as part of the Breast Cancer Family Registries, and through cooperative agreements with the Fox Chase Cancer Center, Huntsman Cancer Institute, Columbia University, Northern California Cancer Center, Cancer Care Ontario, and the University of Melbourne. M.R.E.McC. was supported in New Zealand by the Inkster Ross Memorial Fund of the University of Otago.

Poster discussion presented at the Annual Meeting of the American Society of Clinical Oncology, May 31–June 3, 2003, Chicago, IL.

The content of this manuscript does not necessarily reflect the views or policies of the National Cancer Institute or any of collaborating centers in the Breast Cancer Family Registries, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government or the Cancer Family Registries.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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