Pregnancy-Related Factors and Breast Cancer Risk for Women Across a Range of Familial Risk

Kathleen Cuningham Foundation Consortium investigators

Research output: Contribution to journalArticlepeer-review

Abstract

IMPORTANCE: Few studies have investigated whether the associations between pregnancy-related factors and breast cancer (BC) risk differ by underlying BC susceptibility. Evidence regarding variation in BC risk is critical to understanding BC causes and for developing effective risk-based screening guidelines.

OBJECTIVE: To examine the association between pregnancy-related factors and BC risk, including modification by a of BC where scores are based on age and BC family history.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study included participants from the prospective Family Study Cohort (ProF-SC), which includes the 6 sites of the Breast Cancer Family Registry (US, Canada, and Australia) and the Kathleen Cuningham Foundation Consortium (Australia). Analyses were performed in a cohort of women enrolled from 1992 to 2011 without any personal history of BC who were followed up through 2017 with a median (range) follow-up of 10 (1-23) years. Data were analyzed from March 1992 to March 2017.

EXPOSURES: Parity, number of full-term pregnancies (FTP), age at first FTP, years since last FTP, and breastfeeding.

MAIN OUTCOMES AND MEASURES: BC diagnoses were obtained through self-report or report by a first-degree relative and confirmed through pathology and data linkages. Cox proportional hazards regression models estimated hazard ratios (HR) and 95% CIs for each exposure, examining modification by PARS of BC. Differences were assessed by estrogen receptor (ER) subtype.

RESULTS: The study included 17 274 women (mean [SD] age, 46.7 [15.1] years; 791 African American or Black participants [4.6%], 1399 Hispanic or Latinx participants [8.2%], and 13 790 White participants [80.7%]) with 943 prospectively ascertained BC cases. Compared with nulliparous women, BC risk was higher after a recent pregnancy for those women with higher PARS (last FTP 0-5 years HR for interaction, 1.53; 95% CI, 1.13-2.07; P for interaction < .001). Associations between other exposures were limited to ER-negative disease. ER-negative BC was positively associated with increasing PARS and increasing years since last FTP (P for interaction < .001) with higher risk for recent pregnancy vs nulliparous women (last FTP 0-5 years HR for interaction, 1.54; 95% CI, 1.03-2.31). ER-negative BC was positively associated with increasing PARS and being aged 20 years or older vs less than 20 years at first FTP (P for interaction = .002) and inversely associated with multiparity vs nulliparity (P for interaction = .01).

CONCLUSIONS AND RELEVANCE: In this cohort study of women with no prior BC diagnoses, associations between pregnancy-related factors and BC risk were modified by PARS, with greater associations observed for ER-negative BC.

Original languageEnglish
Pages (from-to)e2427441
JournalJama Network Open
Volume7
Issue number8
DOIs
StatePublished - Aug 26 2024

Keywords

  • Adult
  • Australia/epidemiology
  • Breast Feeding/statistics & numerical data
  • Breast Neoplasms/genetics
  • Canada/epidemiology
  • Cohort Studies
  • Female
  • Genetic Predisposition to Disease
  • Humans
  • Middle Aged
  • Parity
  • Pregnancy
  • Prospective Studies
  • Registries
  • Risk Factors
  • United States/epidemiology

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