title: The influence of menstrual risk factors on tumor characteristics and survival in postmenopausal breast cancer.
abstract: BACKGROUND
  Hormonal factors are implicated in tumor progression and it is possible that factors influencing breast cancer induction could affect prognosis. Our study investigated the effects of menstrual risk factors on tumor characteristics and survival in postmenopausal breast cancer.
  
  
  METHODS
  We used a nationwide, population-based, case-case design of 2,640 Swedish women who were 50 to 74 years old and had postmenopausal breast cancer during 1993 to 1995. Follow-up was conducted until 31 December 2000. We used polytomous multiple logistic regression to investigate the relationships between menstrual factors (age at menarche, cycle length, irregular menstruation, lifetime number of menstrual cycles, and age at menopause), tumor characteristics (size, grade, estrogen receptor and progesterone receptor [PR] status, lymph node involvement, and histology), and Cox proportional hazards modeling for 5-year survival.
  
  
  RESULTS
  Younger ages at menarche were significantly associated with grade and lymph node involvement. Women with an age at menarche of 11 years or younger had a more than twofold excess risk of medium-grade (odds ratio [OR] = 2.05; 95% confidence interval [CI] 1.00 to 4.18) and high-grade (OR = 2.04; 95% CI 1.01 to 4.16) tumors. Early menarche significantly increased the risk of lymph node metastases. Survival was poorest in women with the earliest age at menarche, with a 72% increased risk of dying within 5 years after diagnosis (hazard ratio = 1.72; 95% CI 1.02 to 2.89). No significant associations were observed for other menstrual factors with tumor characteristics or survival.
  
  
  CONCLUSIONS
  Age at menarche has a significant impact on breast cancer prognosis and survival. It remains to be established whether the associations are attributable to age at menarche directly or are associated with the early-life physiological events of breast development and carcinogenesis also taking place during childhood and puberty, as menarche is only the culmination of this series of events.
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, Stockholm, SE-17177, Sweden. chantal.orgeas@ki.se
authors.forename: Chantal C
authors.initials: CC
authors.lastname: Orgéas
authors.forename: Per
authors.initials: P
authors.lastname: Hall
authors.forename: Lena U
authors.initials: LU
authors.lastname: Rosenberg
authors.forename: Kamila
authors.initials: K
authors.lastname: Czene
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D001943:Breast Neoplasms / Q000209:etiology / Q000401:mortality*; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008572:Menarche; D008598:Menstruation; D008599:Menstruation Disturbances; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D017698:Postmenopause; D012307:Risk Factors; D015996:Survival Rate; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult