Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, Canada Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, Quebec, Canada Department of Obstetrics and Gynecology, Royal Victoria Hospital, McGill University, Montreal, Canada.
Breast cancer in pregnancy is a rare condition. The objective of our study was to describe the incidence, risk factors, and obstetrical outcomes of breast cancer in pregnancy. We conducted a population-based cohort study on 8.8 million births using data from the Healthcare Cost and Utilization Project - Nationwide Inpatient Sample from 1999-2008. The incidence of breast cancer was calculated and logistic regression analysis was used to evaluate the independent effects of demographic determinants on the diagnosis of breast cancer and to estimate the adjusted effect of breast cancer on obstetrical outcomes. There were 8,826,137 births in our cohort of which 573 cases of breast cancer were identified for an overall 10-year incidence of 6.5 cases per 100,000 births with the incidence slightly increasing over the 10-year period. Breast cancer appeared to be more common among women >35 years of age, odds ratio (OR) = 3.36 (2.84-3.97); women with private insurance plans, OR = 1.39 (1.10-1.76); and women who delivered in an urban teaching hospital, OR = 2.10 (1.44-3.06). After adjusting for baseline characteristics, women with pregnancy-associated breast cancer were more likely to have an induction of labor, OR = 2.25 (1.88, 2.70), but similar rates of gestational diabetes, preeclampsia, instrumental deliveries, and placental abruption. The incidence of breast cancer in pregnancy appears higher than previously reported with women over 35 being at greatest risk. Aside from an increased risk for induction of labor, women with breast cancer in pregnancy have similar obstetrical outcomes.
"Identifying high-risk subgroups of premenopausal women is necessary for intervention and early detection. However, risk factors for PABC are not well understood  . As an understudied population, indigenous African women tend to have high parity and relatively young ages at diagnosis of breast cancer, making pregnancy and lactation more likely to coexist with breast cancer than among Western populations . "
[Show abstract][Hide abstract] ABSTRACT: Little is known about risk factors for pregnancy-associated breast cancer (PABC), diagnosed during pregnancy or postpartum.
We enrolled 1715 premenopausal women from the Nigerian Breast Cancer Study from 1998 to 2011. Based on recency of last pregnancy from diagnosis, breast cancer cases were categorized as (1) PABC diagnosed 2 years or longer postpartum, (2) PABC diagnosed 3 to 5 years postpartum, or (3) non-PABC diagnosed more than 5 years postpartum. Controls were matched to cases on recency of last pregnancy. Multiple logistic regressions were performed comparing cases and controls within each group.
Of the 718 cases, 152 (21.2%) had PABC 2 or more years postpartum, and 145 (20.2%) 3 to 5 years postpartum. Although not statistically significant, women with higher parity tend to have an elevated risk of PABC but reduced risk of non-PABC (p for heterogeneity = 0.097). Family history of breast cancer might be a strong predictor particularly for PABC 2 or more years postpartum (odds ratio, 3.28; 95% confidence interval, 1.05-10.3). Compared with non-PABC cases, PABC 2 or more years postpartum cases were more likely to carry BRCA1/2 mutations (P = .03).
Parity may have different roles in the development of PABC versus other premenopausal breast cancer in Nigerian women. Prospective mothers with multiple births and a family history of breast cancer may have an elevated risk of breast cancer during their immediate postpartum period.
Annals of epidemiology 07/2013; 23(9). DOI:10.1016/j.annepidem.2013.06.008 · 2.00 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Patients at young age (≤35 years) diagnosed with breast cancer (BC) are considered to have poor prognosis. The aim of the present study was to retrospectively analyse clinicopathological characteristics and prognosis in a group of young BC patients. We included women diagnosed with invasive breast carcinoma younger than/or at the age of 35 years. Between 1999 and 2009, 107 women with early-onset BC were selected from the database of the 2nd Department of Pathology at Semmelweis University. For clinicopathological comparison, 55 women (36-45 years), 214 women (46-65 years), 110 women (66-75 years) and 58 women (76≤ years) were also included in the analysis. Family history, clinicopathological and follow-up data were analysed. The tissue specimens were reviewed for histological type, nuclear grade, and estrogen receptor (ER), progesterone receptor (PgR), Ki67 and HER2 status (IHC4). The mean age in the study group was 31.6 years at the time of diagnosis. Histology showed a high incidence of grade III tumours in this group of patients (67.9 %), while only four cases (3.8 %) were considered grade I. According to the immunohistochemical results, 35.3 % of the study cases were considered as Luminal B (LumB: either being higly proliferative or co-expressing HER2) and 33.3 % as triple negative breast carcinomas (TNBC). The detailed questionnaire related to family history was completed and received in 49/107 cases (45.8 %). Analysis of these data revealed an affected family history of breast or ovarian carcinoma in first and second degree relatives in 51.0 %. A high proportion (52.0 %) of TNBC was observed among young women with a family history of the disease. Survival analysis of the 107 patients showed that 25 (23.3 %) women died until 31 December 2012. No significant difference in survival was detectable considering the regimen of systemic treatment (p = 0.188). Regarding clinicopathological parameters, the immunophenotypes, grade, pT and pN values differred substantially between the age groups (p = 0.001, for all), and the shortest relapse-free survival was seen among the youngest BC patients. This analysis illustrates that breast cancer arising in young women is characterized by the presence of less favorable subtypes such as LumB and TNBC. The increased proportion of TNBC was especially remarquable in the group of patients presenting with family history of the disease. The fact that a high rate of death occured and no significant difference in OS were notable regarding the scheme of systemic therapies (neoadjuvant vs. adjuvant) highlight the necessity of the development of new treatment strategies.
[Show abstract][Hide abstract] ABSTRACT: To estimate the incidence of pregnancy-associated cancer during a 30-year period in Denmark on the basis of both births and abortions with and without age adjustment and age standardization.
Using data from the nationwide Danish registries, we investigated the occurrence of pregnancy-associated cancer (defined as cancer diagnosed during pregnancy and up to 1 year after pregnancy has ended) in pregnancies resulting in a birth (live birth or stillbirth) or an abortion. We included patients with primary cancer diagnosed at ages 15-44 years during 1977-2006 according to the Danish Cancer Registry. The patients were linked to the Medical Birth Registry, the Registry for Induced Abortions, and the National Patient Registry to obtain information on pregnancies.
We identified 2,426 patients with pregnancy-associated cancer. The three most frequent types were melanoma, cervical cancer, and breast cancer. We found an increase in the total numbers of all pregnancy-associated cancers from 572 cases during 1977-1986 to 1,052 cases during 1997-2006. The proportions of all pregnancy-associated cancers among all cancers increased from 5.4% to 8.3% during the same periods. The overall crude incidence rate of all pregnancy-associated cancer was 89.6 out of 100,000 pregnancies. The crude incidence increased over time, with an average annual percentage change of 2.9% (95% confidence interval [CI] 2.4-3.3). After age adjustment, the increase was still statistically significant (1.6%, 95% CI 1.1-2.1).
We found a statistically significant increase in pregnancy-associated cancer during the 30-year study period. The tendency to postpone childbirth only partly explains the increase in incidence rates. LEVEL OF EVIDENCE:: III.
Obstetrics and Gynecology 08/2013; 122(3). DOI:10.1097/AOG.0b013e3182a057a2 · 5.18 Impact Factor
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