title: Pregnancy-associated breast cancer in women from Shanghai: risk and prognosis.
abstract: Breast cancer (BC) has been associated with pregnancy if diagnosed within 5-10 years after delivery (pregnancy-associated BC, PABC). PABC carries a poor prognosis compared to sporadic BC in Western populations. Data are limited regarding PABC in Asian populations, where longer periods of breastfeeding, higher birth rates and a lower median age of BC at diagnosis have been noted, all of which are known to influence prognosis. We used two datasets of women treated for early BC in Shanghai 1990-2012 (n = 10,161 and n = 7,411). For the analysis of BC risk after pregnancy we compared the distribution of pregnancy in our dataset to that in Shanghai using age-specific fertility rates. For disease-free survival (DFS) evaluation, we restricted our data to women ≤45 years. Women <30 years had a significantly elevated BC risk within 5 years of completing a pregnancy compared to women who had not been pregnant in the previous 5 years. In women aged 20-24 the relative risk (RR) was 3.33 (P = 0.012), and for women aged 25-29 the RR was 1.76 (P = 0.0074). For women >30, the RR was decreased. Patients with PABC had a higher risk of recurrence or death (hazard ratio (HR) for DFS 1.72, P = 0.019) compared to women with non-PABC by univariable analysis. Age was eliminated from the multivariable model by backward selection, resulting in tumor stage (3 versus 1, HR 3.08, P < .001) and recent pregnancy (HR 1.62, P < 0.05) as significant independent prognosticators. Having had a full-term pregnancy in the previous 5 years was associated with a 62 % increased risk of recurrence. We show that recent full-term pregnancy significantly elevates BC risk in women <30 in Shanghai, and that women diagnosed with PABC have a particularly adverse prognosis. Health care providers and women in Asian populations should be made aware of these results.
authors.affiliation: Wilhelminen Hospital, Vienna, Austria.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Strasser-Weippl
authors.forename: Ritesh
authors.initials: R
authors.lastname: Ramchandani
authors.forename: Lei
authors.initials: L
authors.lastname: Fan
authors.forename: Junjie
authors.initials: J
authors.lastname: Li
authors.forename: Marc
authors.initials: M
authors.lastname: Hurlbert
authors.forename: Dianne
authors.initials: D
authors.lastname: Finkelstein
authors.forename: Zhi-Ming
authors.initials: ZM
authors.lastname: Shao
authors.forename: Paul E
authors.initials: PE
authors.lastname: Goss
mesh_terms: D000328:Adult; D000367:Age Factors; D001943:Breast Neoplasms / Q000150:complications / Q000453:epidemiology* / Q000473:pathology; D002681:China; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000150:complications / Q000453:epidemiology* / Q000473:pathology; D049590:Postpartum Period; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000453:epidemiology* / Q000473:pathology; D011379:Prognosis