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Pregnancy Characteristics and Maternal Risk of Breast Cancer
Sven Cnattingius, MD, PhD;
Anna Torrång, BSc;
Anders Ekbom, MD, PhD;
Fredrik Granath, PhD;
Gunnar Petersson, BSc;
Mats Lambe, MD, PhD
JAMA. 2005;294:2474-2480.
Context During pregnancy, serum levels of estrogen, progesterone, and other hormones are markedly higher than during other periods of life. Pregnancy hormones primarily are produced in the placenta, and signs of placental impairment may serve as indirect markers of hormone exposures during pregnancy. During pregnancy, these markers have been inconsistently associated with subsequent risk of breast cancer in the mother.
Objective To examine associations between indirect markers of hormonal exposures, such as placental weight and other pregnancy characteristics, and maternal risk of developing breast cancer.
Design and Setting Population-based cohort study using data from the Swedish Birth Register, the Swedish Cancer Register, the Swedish Cause of Death Register, and the Swedish Register of Population and Population Changes.
Participants Women included in the Sweden Birth Register who delivered singletons between 1982 and 1989, with complete information on date of birth and gestational age. Women were followed up until the occurrence of breast cancer, death, or end of follow-up (December 31, 2001). Cox proportional hazards models were used to estimate associations between hormone exposures and risks of breast cancer.
Main Outcome Measure Incidence of invasive breast cancer.
Results Of 314 019 women in the cohort, 2216 (0.7%) developed breast cancer during the follow-up through 2001, of whom 2100 (95%) were diagnosed before age 50 years. Compared with women who had placentas weighing less than 500 g in 2 consecutive pregnancies, the risk of breast cancer was increased among women whose placentas weighed between 500 and 699 g in their first pregnancy and at least 700 g in their second pregnancy (or vice versa) (adjusted hazard ratio, 1.82; 95% confidence interval [CI], 1.07-3.08), and the corresponding risk was doubled among women whose placentas weighed at least 700 g in both pregnancies (adjusted hazard ratio, 2.05; 95% CI, 1.15-3.64). A high birth weight ( 4000 g) in 2 successive births was associated with an increased risk of breast cancer before but not after adjusting for placental weight and other covariates (adjusted hazard ratio, 1.10; 95% CI, 0.76-1.59).
Conclusions Placental weight is positively associated with maternal risk of breast cancer. These results further support the hypothesis that pregnancy hormones are important modifiers of subsequent maternal breast cancer risk.
Author Affiliations: Department of Medical Epidemiology and Biostatistics (Drs Cnattingius and Lambe, Ms Torrång, and Mr Petersson) and Unit of Clinical Epidemiology, Department of Medicine (Drs Ekbom and Granath), Karolinska Hospital, Karolinska Institutet, Stockholm, Sweden; and AstraZeneca R&D, Mölndal, Sweden (Dr Lambe).
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