Mortality from breast, endometrial and ovarian cancers among grand multiparous women in Taiwan

Parity Differently Affects the Breast Cancer Specific Survival from Ductal Carcinoma In Situ to Invasive Cancer: A Registry-Based Retrospective Study from Korea

Purpose:

Multiparity might increase general mortality for women, but has inconclusive in patients with breast cancer. Here, we aim to discover their effect in terms of the breast cancer development hypothesis: from ductal carcinoma in situ to invasive carcinoma.

Methods:

We included 37 947 patients from the web-based breast cancer registration program of the Korean Breast Cancer Society and analyzed survivals using multivariate Cox regression analysis and whether the associations of these factors displayed linear trends. They were divided into the following groups: (1) pure ductal carcinoma in situ (DCIS), (2) invasive ductal carcinoma (IDC) mixed with intraductal component (DCIS-IDC), and (3) node negative pure IDC.

Results:

The mean age was 48.9 ± 9.9 years including premenopausal women was 61.8%. Although patients with parities of 1-3 had better prognosis compared with patients with nulliparous women, high parity (⩾4) increased the hazard ratio (HR) of overall survival (OS) (DCIS: HR, 1.52; 95% confidence interval [CI] 0.62-3.78; IDC: HR, 1.43, 95% CI 0.89-2.31; and DCIS-IDC: HR, 1.44, 95% CI 0.45-4.59) during 84.2 (±10.7) months. For breast cancer specific survival (BCSS), the HR of the IDC group (P-value for trend = .04) increased along with increasing parity and was worse than nulliparous patients, and the HR of the DCIS-IDC group increased but was better than nulliparous patients (P-value for trend = .02). Compared with nulliparous patients, any age at first birth (AFB) decreased HR of OS in the DCIS and IDC groups (DCIS: P = .01; IDC: P = .04).

Conclusions:

Parity show dual effects on OS of women with all ductal typed breast cancer but show different effects on BCSS in Korea.

Grand multiparity and reproductive cancer in the Jerusalem Perinatal Study Cohort

OBJECTIVES

Grand multiparity is associated with reduced mortality from reproductive cancers. We aimed to separate the components of mortality, by measuring incidence of and survival after reproductive cancer onset in grand multiparous compared to other parous women.

STUDY DESIGN

We linked data from the population-based Jerusalem Perinatal Study Cohort, which included women aged 13-55 who delivered 1964-1976, with Israel's National Cancer Registry. We compared breast and gynecologic cancer risk and all-cause survival following a cancer diagnosis, among grand multiparae (GMPs = parity 5+, n = 8,246) versus women with parity 1-4 (n = 19,703), adjusting for reproductive and demographic variables.

RESULTS

Grand multiparae were at significantly lower risk of breast cancer than others (adjusted hazard ratio (HRadj) = 0.62, 95 % confidence interval (CI) 0.54-0.71), after controlling for age at first birth, education, and other covariates. This reduction was greater among GMPs whose first birth occurred after age 30 (p-interaction = 0.0001) and for cancer occurring before age 50 years (p = 0.002). In contrast, GMPs were at greater risk of death than women with parity <5, following a breast cancer diagnosis (HRadj = 1.69, CI 1.39-2.1). Ovarian, uterine, and cervical cancer incidence did not differ between the groups, but survival was reduced for GMPs with uterine cancer (HRadj = 2.48, CI 1.22-5.03).

CONCLUSION

Reduced reproductive cancer mortality reported among GMPs masks two opposing phenomena: decreased breast cancer risk and poorer survival after breast and uterine cancers. The latter unfavorable outcome suggests that tumors in GMPs may be particularly aggressive, having perhaps escaped protective mechanisms conferred by parity. This finding calls for heightened clinical attention in this group.

Mortality from cancers of the digestive system among grand multiparous women in Taiwan

The aim of this study is to evaluate the significance of grand multiparous (GM) status in the mortality from cancers of the digestive system among a cohort of GM women in Taiwan during the period 1978-2008. The study cohort consisted of 144,922 women with at least five children (GM women) in the Taiwan Birth Register between 1 January 1978 and 31 December 2003. Standardized mortality ratios (SMRs) for cancers of the digestive system including esophagus, stomach, colon, rectum, liver, and pancreas were calculated by dividing the numbers of observed cancer deaths to the expected numbers of deaths based on the rates of national female population. Among the 144,922 GM women, a total of 23, 220, 213, 92, 397, and 65 deaths were caused by cancers of the esophagus, stomach, colon, rectum, liver, and pancreas, respectively. The SMRs among GM women were 1.61 (95% confidence intervals (CI): 0.95-2.27) for esophageal cancer, 1.15 (95% CI: 1.00-1.31) for stomach cancer, 1.07 (95% CI: 0.93-1.22) for colon cancer, 0.94 (95% CI: 0.75-1.14) for rectal cancer, 1.18 (95% CI: 1.06-1.30) for liver cancer, and 0.79 (95% CI: 0.60-0.98) for pancreatic cancer. This study provides evidence that grand multiparity may confer a protective effect on the risk of death from pancreatic cancer. However, the results suggest that GM women may increase the risk of death from cancers of the liver and stomach.

The occurrence of fetal microchimeric cells in endometrial tissues is a very common phenomenon in benign uterine disorders, and the lower prevalence of fetal microchimerism is associated with better uterine cancer prognoses

This is the first study carried out to describe the role of fetal microchimerism (FM) in the pathogenesis of uterine cancer. The prevalence and concentration of male fetal microchimeric cells (FMCs) were examined in endometrial tissues in relation to subtypes of uterine cancer, and the histological grade and stage of the tumor. FM occurrence was analyzed in relation to risk factors, including hypertension, obesity, type 2 diabetes, dyslipidemia, age at cancer diagnosis, and patient pregnancy history. The prevalence and concentration of FMCs were examined in endometrial tissues using real-time polymerase chain reaction, SRY and β-globin sequences as markers for male fetal FMCs and total DNA. The studied group involved 47 type 1 endometrial cancers, 28 type 2 endometrial cancers, and 41 benign uterine diseases. While the prevalence of FM was decreased only in type 1 endometrial cancer, compared with benign uterine disorders (38.3% vs.70.7%; odds ratio [OR]=0.257, 95% confidence interval [CI]: 0.105 to 0.628, p=0.003), FMC concentrations did not differ within examined groups. The lower FM prevalence was detected in low-grade (grade 1 and grade 2) endometrioid cancer (38.3% vs. 70.7%, OR=0.256, 95% CI: 0.105 to 0.627, p=0.003) and in FIGO 1 tumors (40.7% vs. 70.7%, OR=0.285, 95% CI: 0.120 to 0.675, p=0.004). No correlation between FM prevalence or FMC concentrations and risk factors was demonstrated. A lower prevalence of male FM seemed to be associated with better prognoses in uterine cancer based on tumor subtype, histological grade, and stage of the tumor.

Do reproductive factors influence T, N, and M classes of ductal and lobular breast cancers? A nation-wide follow-up study

BACKGROUNDS

The clinical tumor-node-metastasis (T, N and M) classes of breast cancers provide important prognostic information. However, the possible association of TNM classes with reproductive factors has remained largely unexplored. Because every woman has a reproductive history, implications to outcome prediction are potentially significant.

METHODS

During the study period from 2002 through 2008, 5,614 pre- and 27,310 postmenopausal patients were identified in the Swedish Family-Cancer Database. Ordinal logistic regression analysis was used to estimate odds ratios (ORs) for TNM classes of breast cancers by histology. The reproductive variables were parity, age at first and last childbirth and time interval between first and last childbirth.

RESULTS

Among postmenopausal patients, the ORs for high-T class (T2-T4) (tumor size ≥2 cm) and metastasis were decreased by parity. A late age at first and last childbirth associated with high-T class and the effects were higher for lobular (OR for late age at first childbirth  = 2.85) than ductal carcinoma. Overall, long time interval between first and last childbirth was related to high-T class and metastasis. However, a short time interval between first and last childbirth in patients with late age at first or last childbirth increased the risk of metastasis. Late age at last childbirth was associated with increased occurrence of lobular carcinoma in situ. Among premenopausal ductal carcinoma patients, nulliparity and early age at first childbirth were associated with high-T class.

CONCLUSIONS

Increasing parity was protective against high-T class and metastasis; late ages at first and last childbirth were risk factors for high-T class in postmenopausal breast cancers. The current decline in parity and delayed age at first childbirth in many countries may negatively influence prognosis of breast cancer.