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Pregnancy-associated breast cancer in women from Shanghai: risk and prognosis

  • Epidemiology
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Abstract

Breast cancer (BC) has been associated with pregnancy if diagnosed within 5–10 years after delivery (pregnancy-associated BC, PABC). PABC carries a poor prognosis compared to sporadic BC in Western populations. Data are limited regarding PABC in Asian populations, where longer periods of breastfeeding, higher birth rates and a lower median age of BC at diagnosis have been noted, all of which are known to influence prognosis. We used two datasets of women treated for early BC in Shanghai 1990–2012 (n = 10,161 and n = 7,411). For the analysis of BC risk after pregnancy we compared the distribution of pregnancy in our dataset to that in Shanghai using age-specific fertility rates. For disease-free survival (DFS) evaluation, we restricted our data to women ≤45 years. Women <30 years had a significantly elevated BC risk within 5 years of completing a pregnancy compared to women who had not been pregnant in the previous 5 years. In women aged 20–24 the relative risk (RR) was 3.33 (P = 0.012), and for women aged 25–29 the RR was 1.76 (P = 0.0074). For women >30, the RR was decreased. Patients with PABC had a higher risk of recurrence or death (hazard ratio (HR) for DFS 1.72, P = 0.019) compared to women with non-PABC by univariable analysis. Age was eliminated from the multivariable model by backward selection, resulting in tumor stage (3 versus 1, HR 3.08, P < .001) and recent pregnancy (HR 1.62, P < 0.05) as significant independent prognosticators. Having had a full-term pregnancy in the previous 5 years was associated with a 62 % increased risk of recurrence. We show that recent full-term pregnancy significantly elevates BC risk in women <30 in Shanghai, and that women diagnosed with PABC have a particularly adverse prognosis. Health care providers and women in Asian populations should be made aware of these results.

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Acknowledgments

This work was supported be the Avon Foundation, NY.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

This study complies with the law in Shanghai.

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Authors and Affiliations

  1. Wilhelminen Hospital, Vienna, Austria

    Kathrin Strasser-Weippl

  2. Massachusetts General Hospital Biostatistics Center, Boston, MA, USA

    Ritesh Ramchandani & Dianne Finkelstein

  3. Breast Cancer Institute, Fudan University, 399 Ling-Ling Road, Shanghai, 200032, People’s Republic of China

    Lei Fan, Junjie Li & Zhi-Ming Shao

  4. Avon Foundation for Women, New York, NY, USA

    Marc Hurlbert & Paul E. Goss

  5. Massachusetts General Hospital Cancer Center, Boston, MA, USA

    Marc Hurlbert & Paul E. Goss

Authors
  1. Kathrin Strasser-Weippl
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  2. Ritesh Ramchandani
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  3. Lei Fan
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  4. Junjie Li
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  5. Marc Hurlbert
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  7. Zhi-Ming Shao
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  8. Paul E. Goss
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Correspondence to Zhi-Ming Shao.

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Strasser-Weippl, K., Ramchandani, R., Fan, L. et al. Pregnancy-associated breast cancer in women from Shanghai: risk and prognosis. Breast Cancer Res Treat 149, 255–261 (2015). https://doi.org/10.1007/s10549-014-3219-9

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  • DOI: https://doi.org/10.1007/s10549-014-3219-9

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