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Time since childbirth and prognosis in primary breast cancer: population based study
N Kroman1, J Wohlfahrt, K W Andersen
1Surgical Department A, Hillerød Hospital, Denmark.
Objective:
To investigate whether time since birth of last child was of prognostic importance in women with primary breast cancer.
Design:
Retrospective cohort study based on a population based database of breast cancer diagnoses with detailed information on tumour characteristics, treatment regimens, reproductive factors, and vital status.
Setting:
Denmark.
Subjects:
5652 women with primary breast cancer aged 45 years or less at the time of diagnosis.
Main Outcome Measures:
5 and 10 year survival; relative risk of dying.
Results:
Women diagnosed in the first 2 years after last childbirth had a crude 5 year survival of 58.7% and 10 year survival of 46.1% compared with 78.4% and 66.0% for women whose last childbirth was more than 2 years before their diagnosis. After adjustment for age, reproductive factors, and stage of disease (tumour size, axillary nodal status, and histological grading), a diagnosis sooner than 2 years since last childbirth was significantly associated with a poor survival (relative risk 1.58, 95% confidence interval 1.24 to 2.02) compared with women who gave birth more than 5 years previously. Further analyses showed that the effect was not modified by age at diagnosis, tumour size, and nodal status.
Conclusions:
A diagnosis of breast cancer less than 2 years after having given birth is associated with a particularly poor survival irrespective of the stage of disease at debut. Therefore, a recent pregnancy should be regarded as a negative prognostic factor and should be considered in counselling these patients and in the decisions regarding adjuvant treatment.