title: Histological type and grade of breast cancer tumors by parity, age at birth, and time since birth: a register-based study in Norway.
abstract: BACKGROUND
  Some studies have indicated that reproductive factors affect the risk of histological types of breast cancer differently. The long-term protective effect of a childbirth is preceded by a short-term adverse effect. Few studies have examined whether tumors diagnosed shortly after birth have specific histological characteristics.
  
  
  METHODS
  In the present register-based study, comprising information for 22,867 Norwegian breast cancer cases (20-74 years), we examined whether histological type (9 categories) and grade of tumor (2 combined categories) differed by parity or age at first birth. Associations with time since birth were evaluated among 9709 women diagnosed before age 50 years. Chi-square tests were applied for comparing proportions, whereas odds ratios (each histological type vs. ductal, or grade 3-4 vs. grade 1-2) were estimated in polytomous and binary logistic regression analyses.
  
  
  RESULTS
  Ductal tumors, the most common histological type, accounted for 81.4% of all cases, followed by lobular tumors (6.3%) and unspecified carcinomas (5.5%). Other subtypes accounted for 0.4%-1.5% of the cases each. For all histological types, the proportions differed significantly by age at diagnoses. The proportion of mucinous and tubular tumors decreased with increasing parity, whereas Paget disease and medullary tumors were most common in women of high parity. An increasing trend with increasing age at first birth was most pronounced for lobular tumors and unspecified carcinomas; an association in the opposite direction was seen in relation to medullary and tubular tumors. In age-adjusted analyses, only the proportions of unspecified carcinomas and lobular tumors decreased significantly with increasing time since first and last birth. However, ductal tumors, and malignant sarcomas, mainly phyllodes tumors, seemed to occur at higher frequency in women diagnosed <2 years after first childbirth. The proportions of medullary tumors and Paget disease were particularly high among women diagnosed 2-5 years after last birth. The high proportion of poorly differentiated tumors in women with a recent childbirth was partly explained by young age.
  
  
  CONCLUSIONS
  Our results support previous observations that reproductive factors affect the risk of histological types of breast cancer differently. Sarcomas, medullary tumors, and possible also Paget disease, may be particularly susceptible to pregnancy-related exposure.
authors.affiliation: Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway. msega@uib.no
authors.forename: Grethe
authors.initials: G
authors.lastname: Albrektsen
authors.forename: Ivar
authors.initials: I
authors.lastname: Heuch
authors.forename: Steinar Ø
authors.initials: SØ
authors.lastname: Thoresen
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000453:epidemiology / Q000209:etiology / Q000473:pathology* / Q000517:prevention & control; D002277:Carcinoma / Q000453:epidemiology / Q000209:etiology / Q000473:pathology* / Q000517:prevention & control; D002454:Cell Differentiation; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D016015:Logistic Models; D008423:Maternal Age; D008875:Middle Aged; D009367:Neoplasm Staging; D009664:Norway / Q000453:epidemiology; D016017:Odds Ratio; D010144:Paget's Disease, Mammary / Q000209:etiology / Q000473:pathology; D010298:Parity; D011247:Pregnancy; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult