Elena Shagisultanova1, Dexiang Gao2, Eryn Callihan1, Hannah J Parris1, Betsy Risendal3, Lisa M Hines4, Martha L Slattery5, Kathy Baumgartner6, Pepper Schedin7, Esther M John8, Virginia F Borges9. 1. Young Women's Breast Cancer Program, University of Colorado Cancer Center, Aurora, CO, USA; Division of Medical Oncology, University of Colorado Denver, Aurora, CO, USA. 2. Department of Biostatistics and Bioinformatics, University of Colorado Denver, Aurora, CO, USA. 3. Colorado School of Public Health, University of Colorado Denver, Aurora, CO, USA. 4. Department of Biology, University of Colorado at Colorado Springs, Colorado Springs, CO, USA. 5. Department of Medicine, University of Utah, Salt Lake City, UT, USA. 6. Department of Epidemiology and Population Health, School of Public Health & Information Sciences, University of Louisville, Louisville, KY, USA. 7. Young Women's Breast Cancer Program, University of Colorado Cancer Center, Aurora, CO, USA; School of Medicine, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA. 8. Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA; Department of Medicine (Oncology), Stanford University School of Medicine, Stanford, CA, USA. 9. Young Women's Breast Cancer Program, University of Colorado Cancer Center, Aurora, CO, USA; Division of Medical Oncology, University of Colorado Denver, Aurora, CO, USA. Electronic address: virginia.borges@cuanschutz.edu.
Abstract
BACKGROUND: Women diagnosed with breast cancer prior to age 45 years (<45y) and within the first 5 years postpartum (postpartum breast cancer, PPBC) have the greatest risk for distal metastatic recurrence. METHODS: Pooling data from the Colorado Young Women Breast Cancer cohort and the Breast Cancer Health Disparities Study (N = 2519 cases), we examined the association of parity, age, and clinical factors with overall survival (OS) of breast cancer over 15 years of follow-up. RESULTS: Women with PPBC diagnosed at <45y had the lowest OS (p < 0.0001), while OS of nulliparous cases diagnosed at <45y did not differ from OS of cases diagnosed at 45-65y regardless of parity status. After adjustment for study site, race/ethnicity, clinical stage, year of diagnosis and stratification for oestrogen receptor status, PPBC remained an independent factor associated with poor OS. Among cases diagnosed at <45y, nulliparous cases had 1.6 times better OS (hazard ratio (HR) = 0.61, 95%CI 0.42-0.87) compared to those with PPBC, with a more pronounced survival difference among stage I breast cancers (HR = 0.30, 95%CI 0.11-0.79). Among very young women diagnosed at age ≤35y, nulliparous cases had 2.3 times better OS (HR = 0.44, 95%CI 0.23-0.84) compared to PPBC. CONCLUSION: Our results suggest that postpartum status is the main driver of poor prognosis in young women with breast cancer, with the strongest association in patients diagnosed at age ≤35y and in those with stage I disease.
BACKGROUND: Women diagnosed with breast cancer prior to age 45 years (<45y) and within the first 5 years postpartum (postpartum breast cancer, PPBC) have the greatest risk for distal metastatic recurrence. METHODS: Pooling data from the Colorado Young Women Breast Cancer cohort and the Breast Cancer Health Disparities Study (N = 2519 cases), we examined the association of parity, age, and clinical factors with overall survival (OS) of breast cancer over 15 years of follow-up. RESULTS: Women with PPBC diagnosed at <45y had the lowest OS (p < 0.0001), while OS of nulliparous cases diagnosed at <45y did not differ from OS of cases diagnosed at 45-65y regardless of parity status. After adjustment for study site, race/ethnicity, clinical stage, year of diagnosis and stratification for oestrogen receptor status, PPBC remained an independent factor associated with poor OS. Among cases diagnosed at <45y, nulliparous cases had 1.6 times better OS (hazard ratio (HR) = 0.61, 95%CI 0.42-0.87) compared to those with PPBC, with a more pronounced survival difference among stage I breast cancers (HR = 0.30, 95%CI 0.11-0.79). Among very young women diagnosed at age ≤35y, nulliparous cases had 2.3 times better OS (HR = 0.44, 95%CI 0.23-0.84) compared to PPBC. CONCLUSION: Our results suggest that postpartum status is the main driver of poor prognosis in young women with breast cancer, with the strongest association in patients diagnosed at age ≤35y and in those with stage I disease.
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