Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Breast Cancer Research and Treatment
Published in: Breast Cancer Research and Treatment 1/2013

01-11-2013 | Epidemiology

Reproductive factors and risk of premenopausal breast cancer by age at diagnosis: Are there differences before and after age 40?

Authors: Erica T. Warner, Graham A. Colditz, Julie R. Palmer, Ann H. Partridge, Bernard A. Rosner, Rulla M. Tamimi

Published in: Breast Cancer Research and Treatment | Issue 1/2013

Login to get access

Abstract

We examined the relationship between reproductive factors and risk of premenopausal breast cancer among women less than age 40 compared with older premenopausal women. We documented 374 incident cases of breast cancer diagnosed before age 40, and 2,533 cases diagnosed at age 40 and older among premenopausal women in the Nurses’ Health Study cohorts. Biennial questionnaires were used to determine age at menarche, age at first birth, parity, breastfeeding, and other reproductive factors. Multivariate relative risks (RR) and 95 % confidence intervals (CI) were calculated using Cox proportional hazards models within age at diagnosis groups. Tumors in younger women were significantly more likely to be higher grade, larger size, and hormone receptor negative than were tumors in older premenopausal women (p < 0.0001). There was no significant heterogeneity according to age in associations between reproductive factors and risk of premenopausal breast cancer. First birth at age 30 or older increased breast cancer risk in both age groups (age <40: RR 1.10, 95 % CI 0.80–1.50; age ≥40: RR 1.16, 95 % CI 1.02–1.32; p-heterogeneity = 0.44). Risk of premenopausal breast cancer decreased with each additional year of age at menarche in both age groups (age <40: RR 0.93, 95 % CI 0.87–0.99; p trend = 0.02; age ≥40: RR 0.94, 95 % CI 0.91–0.97; p trend = <0.0001). Among premenopausal parous women, breastfeeding was protective regardless of age at diagnosis (age <40: RR 0.84, 95 % CI 0.57–1.22; age ≥40: RR 0.85, 95 % CI 0.72–0.99; p-heterogeneity = 0.79). In the largest prospective examination of reproductive risk factors and risk of breast cancer before and after age 40, we found that younger women were more likely to develop tumors with less favorable prognostic characteristics. However, associations between reproductive factors and risk of breast cancer were similar regardless of age at diagnosis of premenopausal breast cancer.
Literature
1.
2.
Yankaskas BC (2006) Epidemiology of breast cancer in young women. Breast Dis 23:3–8
3.
Anders CK, Johnson R, Litton J et al (2009) Breast cancer before age 40 Years. Semin Oncol 36:237–249PubMedCrossRef
4.
Tarone RE (2006) Breast cancer trends among young women in the United States. Epidemiology 17:588–590PubMedCrossRef
5.
Clarke CA, Glaser SL (2007) Declines in breast cancer after the WHI: apparent impact of hormone therapy. Cancer Causes Control 18:847–852PubMedCrossRef
6.
Johnson RH, Chien FL, Bleyer A (2013) Incidence of breast cancer with distant involvement among women in the United States, 1976 to 2009. JAMA 309:800–805PubMedCrossRef
7.
Tavani A, Gallus S, La Vecchia C et al (1999) Risk factors for breast cancer in women under 40 years. Eur J Cancer 35:1361–1367PubMedCrossRef
8.
Michels KB, Terry KL, Willett WC (2006) Longitudinal study on the role of body size in premenopausal breast cancer. Arch Intern Med 166:2395–2402PubMedCrossRef
9.
Terry KL, Willett WC, Rich-Edwards JW et al (2005) Menstrual cycle characteristics and incidence of premenopausal breast cancer. Cancer Epidemiol Biomarkers Prev 14:1509–1513PubMedCrossRef
10.
Berstad P, Ma H, Bernstein L et al (2008) Alcohol intake and breast cancer risk among young women. Breast Cancer Res Treat 108:113–120PubMedCrossRef
11.
Chan A, Pintilie M, Vallis K et al (2000) Breast cancer in women < or = 35 years: review of 1002 cases from a single institution. Ann Oncol 11:1255–1262PubMedCrossRef
12.
Gligorov J, Guilhaume M, Spielmann M et al (2005) Breast cancer in young women age <36 years: a retrospective analysis of prognostic factors in 926 patients in 8 french instituitions. GETNA group. J Clin Oncol 23:9685
13.
Nyante SJ, Gammon MD, Malone KE et al (2008) The association between oral contraceptive use and lobular and ductal breast cancer in young women. Int J Cancer 122:936–941PubMedCrossRef
14.
Palmer JR, Wise LA, Horton NJ et al (2003) Dual effect of parity on breast cancer risk in African-American women. J Natl Cancer Inst 95:478–483PubMedCrossRef
15.
Yankaskas BC (2005) Epidemiology of breast cancer in young women. Breast Dis 23:3–8PubMed
16.
Zabicki K, Colbert JA, Dominguez FJ et al (2006) Breast cancer diagnosis in women < or = 40 versus 50 to 60 years: increasing size and stage disparity compared with older women over time. Ann Surg Oncol 13:1072–1077PubMedCrossRef
17.
Jatoi I, Chen BE, Anderson WF et al (2007) Breast cancer mortality trends in the United States according to estrogen receptor status and age at diagnosis. J Clin Oncol 25:1683PubMedCrossRef
18.
Althuis MD, Brogan DD, Coates RJ et al (2003) Breast cancers among very young premenopausal women (United States). Cancer Causes Control 14:151–160PubMedCrossRef
19.
Anderson WF, Matsuno RK, Sherman ME et al (2007) Estimating age-specific breast cancer risks: a descriptive tool to identify age interactions. Cancer Causes Control 18:439–447PubMedCrossRef
20.
Peppercorn J, Partridge AH (2008) Breast cancer in young women: a new color or a different shade of pink? J Clin Oncol 26:3303–3305PubMedCrossRef
21.
22.
Collins L, Marotti J, Gelber S et al (2012) Pathologic features and molecular phenotype by patient age in a large cohort of young women with breast cancer. Breast Cancer Res Treat 131:1061–1066PubMedCrossRef
23.
Klauber-DeMore N (2006) Tumor biology of breast cancer in young women. Breast Dis 23:9–15
24.
Ahn SH, Son BH, Kim SW et al (2007) Poor outcome of hormone receptor-positive breast cancer at very young age is due to tamoxifen resistance: nationwide survival data in Korea—a report from the Korean breast cancer society. J Clin Oncol 25:2360–2368PubMedCrossRef
25.
Anders CK, Hsu DS, Broadwater G et al (2008) Young age at diagnosis correlates with worse prognosis and defines a subset of breast cancers with shared patterns of gene expression. J Clin Oncol 26:3324PubMedCrossRef
26.
Bertheau P, Steinberg SM, Merino MJ (1998) C-erbB-2, p53, and nm23 gene product expression in breast cancer in young women: immunohistochemical analysis and clinicopathologic correlation. Hum Pathol 29:323–329PubMedCrossRef
27.
Keegan TH, DeRouen MC, Press DJ et al (2012) Occurrence of breast cancer subtypes in adolescent and young adult women. Breast Cancer Res 14:R55PubMedCrossRef
28.
Axelrod D, Smith J, Kornreich D et al (2008) Breast cancer in young women. J Am Coll Surg 206:1193–1203PubMedCrossRef
29.
Anders CK, Acharya CR, Hsu DS et al (2008) Age-specific differences in oncogenic pathway deregulation seen in human breast tumors. PLoS One 3(1):e1373PubMedCrossRef
30.
Anders CK, Fan C, Parker JS et al (2011) Breast carcinomas arising at a young age: unique biology or a surrogate for aggressive intrinsic subtypes? J Clin Oncol 29:e18–e20PubMedCrossRef
31.
Azim HA, Michiels S, Bedard PL et al (2012) Elucidating prognosis and biology of breast cancer arising in young women using gene expression profiling. Clin Cancer Res 18:1341–1351PubMedCrossRef
32.
Fredholm H, Eaker S, Frisell J et al (2009) Breast cancer in young women: poor survival despite intensive treatment. PLoS One 4:e7695PubMedCrossRef
33.
El Saghir NS, Seoud M, Khalil MK et al (2006) Effects of young age at presentation on survival in breast cancer. BMC Cancer 6:194PubMedCrossRef
34.
Partridge AH, Gelber S, Piccart-Gebhart MJ et al (2013) Effect of age on breast cancer outcomes in women with human epidermal growth factor receptor 2–positive breast cancer: results from a herceptin adjuvant trial. J Clin Oncol 31(21):2692–2698PubMedCrossRef
35.
Yau C, Wang Y, Zhang Y et al (2011) Young age, increased tumor proliferation and FOXM1 expression predict early metastatic relapse only for endocrine-dependent breast cancers. Breast Cancer Res Treat 126:803–810PubMedCrossRef
36.
Rosner B, Colditz GA, Willett WC (1994) Reproductive risk factors in a prospective study of breast cancer: the nurses’ health study. Am J Epidemiol 139:819–835PubMed
37.
Yang XR, Sherman ME, Rimm DL et al (2007) Differences in risk factors for breast cancer molecular subtypes in a population-based study. Cancer Epidemiol Biomarkers Prev 16:439–443PubMedCrossRef
38.
Ursin G, Bernstein L, Lord SJ et al (2005) Reproductive factors and subtypes of breast cancer defined by hormone receptor and histology. Br J Cancer 93:364–371PubMedCrossRef
39.
Colditz GA, Rosner BA, Chen WY et al (2004) Risk factors for breast cancer according to estrogen and progesterone receptor status. J Natl Cancer Inst 96:218–228PubMedCrossRef
40.
Althuis MD, Fergenbaum JH, Garcia-Closas M et al (2004) Etiology of hormone receptor-defined breast cancer: a systematic review of the literature. Cancer Epidemiol Biomarkers Prev 13:1558–1568PubMed
41.
Colditz GA, Rosner B (2000) Cumulative risk of breast cancer to age 70 years according to risk factor status: data from the nurses’ health study. Am J Epidemiol 152:950–964PubMedCrossRef
42.
Pathak DR (2002) Dual effect of first full term pregnancy on breast cancer risk: empirical evidence and postulated underlying biology. Cancer Causes Control 13:295–298PubMedCrossRef
43.
Pathak DR, Speizer FE, Willett WC et al (2006) Parity and breast cancer risk: possible effect on age at diagnosis. Int J Cancer 37:21–25CrossRef
44.
Colditz GA, Hankinson SE (2005) The nurses’ health study: lifestyle and health among women. Nat Rev Cancer 5:388–396PubMedCrossRef
45.
Glynn RJ, Rosner B (2005) Comparison of risk factors for the competing risks of coronary heart disease, stroke, and venous thromboembolism. Am J Epidemiol 162:975–982PubMedCrossRef
46.
Glynn RJ, Rosner B, Christen WG (2009) Evaluation of risk factors for cataract types in a competing risks framework. Ophthalmic Epidemiol 16:98–106PubMedCrossRef
47.
48.
Palmer JR, Boggs DA, Wise LA et al (2011) Parity and lactation in relation to estrogen receptor negative breast cancer in African American women. Cancer Epidemiol Biomarkers Prev 20:1883–1891PubMedCrossRef
49.
Phipps AI, Chlebowski RT, Prentice R et al (2011) Reproductive history and oral contraceptive use in relation to risk of triple-negative breast cancer. J Natl Cancer Inst 103:470–477PubMedCrossRef
50.
Yang XR, Chang-Claude J, Goode EL 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 103:250–263PubMedCrossRef
51.
Setiawan VW, Monroe KR, Wilkens LR et al (2009) Breast cancer risk factors defined by estrogen and progesterone receptor status. Am J Epidemiol 169:1251–1259PubMedCrossRef
52.
Millikan RC, Newman B, Tse CK et al (2008) Epidemiology of basal-like breast cancer. Breast Cancer Res Treat 109:123–139PubMedCrossRef
53.
Li CI, Beaber EF, Tang MC et al (2013) Reproductive factors and risk of estrogen receptor positive, triple-negative, and HER2-neu overexpressing breast cancer among women 20–44 years of age. Breast Cancer Res Treat 137:579–587PubMedCrossRef
54.
Redondo CM, Gago-Domínguez M, Ponte SM et al (2012) Breast feeding, parity and breast cancer subtypes in a Spanish cohort. PLoS One 7:e40543PubMedCrossRef
55.
Colditz GA, Kaphingst KA, Hankinson SE et al (2012) Family history and risk of breast cancer: nurses’ health study. Breast Cancer Res Treat 133:1097–1104PubMedCrossRef
56.
Ellis D, Greenman J, Hodgson S et al (2000) Low prevalence of germline BRCA1 mutations in early onset breast cancer without a family history. J Med Genet 37:792–794PubMedCrossRef
57.
Armes JE, Egan AJM, Southey MC et al (2000) The histologic phenotypes of breast carcinoma occurring before age 40 years in women with and without BRCA1 or BRCA2 germline mutations. Cancer 83:2335–2345CrossRef
58.
Swanson GM, Haslam SZ, Azzouz F (2002) Breast cancer among young African-American women. Cancer 97:273CrossRef
59.
Thadhani R, Stampfer MJ, Hunter DJ et al (1999) High body mass index and hypercholesterolemia risk of hypertensive disorders of pregnancy. Obstet Gynecol 94:543–550PubMedCrossRef
60.
Ghafoor A, Jemal A, Ward E et al (2009) Trends in breast cancer by race and ethnicity. CA Cancer J Clin 53:342–355CrossRef
61.
62.
Cunningham JE, Montero AJ, Garrett-Mayer E et al (2010) Racial differences in the incidence of breast cancer subtypes defined by combined histologic grade and hormone receptor status. Cancer Causes Control 21:399–409PubMedCrossRef
63.
Kurian AW, Fish K, Shema SJ et al (2010) Lifetime risks of specific breast cancer subtypes among women in four racial/ethnic groups. Breast Cancer Res 12:R99PubMedCrossRef
64.
Clarke CA, Keegan TH, Yang J et al (2012) Age-specific incidence of breast cancer subtypes: understanding the black-white crossover. J Natl Cancer Inst 104:1094–1101PubMedCrossRef
Metadata
Title
Reproductive factors and risk of premenopausal breast cancer by age at diagnosis: Are there differences before and after age 40?
Authors
Erica T. Warner
Graham A. Colditz
Julie R. Palmer
Ann H. Partridge
Bernard A. Rosner
Rulla M. Tamimi
Publication date
01-11-2013
Publisher
Springer US
Published in
Breast Cancer Research and Treatment / Issue 1/2013
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI
https://doi.org/10.1007/s10549-013-2721-9

Other articles of this Issue 1/2013

Breast Cancer Research and Treatment 1/2013 Go to the issue

Erratum

Erratum to: CYP3A4 and seasonal variation in vitamin D status in addition to CYP2D6 contribute to therapeutic endoxifen level during tamoxifen therapy

Preclinical study

Reduction of tumor angiogenesis induced by desmopressin in a breast cancer model

Preclinical study

Reevaluation of the proposed autocrine proliferative function of prolactin in breast cancer

Review

Trastuzumab-related cardiac events in the treatment of early breast cancer

Epidemiology

Long-term surveillance mammography and mortality in older women with a history of early stage invasive breast cancer

Clinical trial

Risk of docetaxel-induced peripheral neuropathy among 1,725 Danish patients with early stage breast cancer
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine
Image Credits