Prognosis of Premenopausal Breast Cancer and Childbirth Prior to Diagnosis

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