Association of Parity and Time since Last Birth with Breast Cancer Prognosis by Intrinsic Subtype
Menée aux Etats-Unis à partir de données portant sur 1 140 patientes atteintes d'un cancer du sein, cette étude évalue l'association entre des critères reproductifs (nombre d'enfants, temps écoulé depuis la dernière naissance) et la survie des patientes, en fonction du sous-type de la maladie (durée médiane de suivi : 13,5 ans)
Background:Parity and time since last birth influence breast cancer risk and vary by intrinsic tumor subtype, but the independent effects of these factors on prognosis has received limited attention. Methods:Study participants were 1,140 invasive breast cancer patients from Phases I and II of the population-based Carolina Breast Cancer Study, with tissue blocks available for subtyping using immunohistochemical markers. Breast cancer risk factors, including pregnancy history, were collected via in-person interviews administered shortly after diagnosis. Vital status was determined using the National Death Index. The association of parity and birth recency with breast cancer (BC)-specific and overall survival was assessed using Cox proportional hazards models. Results:During follow-up (median =13.5 years), 450 patients died, 61% due to breast cancer (n=276). High parity (3+ births) and recent birth (< 5 years before diagnosis) were positively associated with BC-specific mortality, independent of age, race, and selected socioeconomic factors (parity, reference=nulliparous, adjusted hazard ratio [HR]=1.76, 95% confidence interval [CI]=1.13-2.73; birth recency, reference=10+ years, adjusted HR=1.29, 95% CI=0.79, 2.11). The associations were stronger among patients with luminal tumors and those surviving longer than 5 years. Conclusions:Parity and recent birth are associated with worse survival among breast cancer patients, particularly among luminal breast cancers and long-term survivors. Impact:The biological effects of parity and birth recency may extend from etiology to tumor promotion and progression.