ABSTRACT: The Relation of Reproductive Factors to Mortality from
Young women with breast cancer have been reported to have an increased
risk of dying from their disease if they have given birth in
<2 years before diagnosis. The prognostic factors associated
with the tumors of these women have not been thoroughly studied.
We examined the tumors of the women who had a recent birth and
compared the tumor characteristics with those of women who were
nulliparous or had given birth 5 years before diagnosis.
study was conducted of 1174 women <45 years old whose invasive
ductal breast cancer was diagnosed from January 1983 to December
1992 in three counties of western Washington.
These women had
participated previously in a population-based, case-control study.
Mean follow-up time was 105.4 months. Histological slides were
collected for 79.1% of the tumors and reviewed by the study pathologist.
Using immunoperoxidase assays, tumor tissue was tested for prognostic
markers for 70.4% of the tumors from the women.
hazards models were used to estimate the relative risk of dying
from breast cancer associated with reproductive events. Logistic
regression was used to obtain estimates of the association between
various reproductive factors and tumor characteristics.
end of follow-up, 48.2% of the women (n = 83) whose last birth
occurred in <2 years of diagnosis had died, compared with
23.3% of nulliparous women (n = 189) and 24.4% of the women (n
= 661) whose last birth was 5 years before diagnosis.
of the women with a recent birth (<2 years before diagnosis)
were more likely to be progesterone receptor negative, odds ratio
(OR) = 2.2, 95% confidence interval (CI) = 1.2-3.9, to be
p53 positive, OR = 2.6, 95% CI = 1.5-4.7, to be of high
histological grade, OR = 5.9, 95% CI = 1.7-20.1, to have
high mitotic count, OR = 2.2, 95% CI = 1.4-4.4, to be node
positive, OR = 2.1, 95% CI = 1.3-3.5, to have a high S phase
fraction, OR = 2.3, 95% CI = 1.1-4.8, and to have a high
American Joint Committee on Cancer stage (III+), OR = 2.8, 95%
CI 1.3-5.8, compared with the tumors of nulliparous women.
After adjusting for tumor characteristics and treatment, the
risk of mortality associated with a birth in <2 years of diagnosis
of breast cancer remained an independent predictor of mortality,
hazard radio (HR) = 2.7, 95% CI = 1.6-4.3.
Our study provides
evidence that reproductive factors influence the biological behavior
of breast cancer in young women and prognosis. Clinicians need
to be aware that women who have delivered a child in <2 years
before diagnosis are at increased risk of having tumors with
especially adverse prognostic profiles and have a poorer survival
rate than women who are nulliparous or whose last birth was some
years in the past.
[03/18/2002; Cancer Epidemiology, Biomarkers and Prevention]
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