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- Title
Association Between Postpartum Breast Cancer Diagnosis and Metastasis and the Clinical Features Underlying Risk.
- Authors
Goddard, Erica T.; Bassale, Solange; Schedin, Troy; Jindal, Sonali; Johnston, Jeremy; Cabral, Ethan; Latour, Emile; Lyons, Traci R.; Mori, Motomi; Schedin, Pepper J.; Borges, Virginia F.
- Abstract
Key Points: Question: Is there an increased risk for metastasis of breast cancers that are diagnosed in young women post partum that extends beyond 5 years from the last childbirth, and what association do standard clinical prognostic factors have with metastatic risk in these young women when categorized by parity? Findings: In a cohort study of 701 women 45 years or younger with breast cancer, those with stage I or II cancer diagnosed up to 10 years post partum had an increased risk for distant metastasis, with both estrogen receptor–positive and estrogen receptor–negative disease significantly affected. Meaning: Postpartum status may be a prognostic indicator in young women with breast cancer and should be routinely identified, as up to 45% of women 45 years or younger with breast cancer fall into this category and could be at increased risk for metastasis. Importance: In women 45 years or younger, breast cancer diagnosis after childbirth increases the risk for metastasis and death, yet limited data exist to define this window of risk and associated prognostic factors. Objective: To assess the window of elevated risk for metastasis following a postpartum breast cancer (PPBC) diagnosis and whether clinical prognostic factors are associated with the increased risk. Design, Setting, and Participants: This multicenter cohort study conducted using cases from the Colorado Young Women's Breast Cancer Cohort diagnosed between January 1, 1981, and December 31, 2014, included 701 women 45 years or younger with stage I to III invasive breast cancer for whom parity data, including time of last childbirth, were available. Data analysis was conducted from July 1 to September 30, 2017. This study involved a tertiary care academic hospital–based breast center and its regional affiliates with cases from the greater Rocky Mountain region. Exposures: Primary exposures were prior childbirth or no childbirth, time between most recent childbirth and breast cancer diagnosis, and time between breast cancer diagnosis and metastasis. Main Outcomes and Measures: The primary outcome was distant metastasis–free survival. Results: A total of 701 women 45 years or younger from the greater Rocky Mountain states region were included in the analysis; mean (SD) age at diagnosis was 37.9 (5.1) years. Breast cancer diagnosis within 10 years after parturition was associated with elevated risk for metastasis, particularly in women with stage I or II disease. In addition, women with PPBC diagnosed within 10 years of a completed pregnancy that was estrogen receptor–positive showed distant metastasis–free survival similar to that of nulliparous patients with estrogen receptor–negative cancer, and women with estrogen receptor–negative PPBC had further reduced metastasis-free survival. Moreover, women with PPBC had increased lymphovascular invasion and lymph node involvement. In addition, tumor-associated Ki67 positivity identified 129 patients with luminal B cancer in the cohort that, independent of parity status, had poorer prognosis compared with patients with luminal A cancer, although it did not reach statistical significance. Conclusions and Relevance: Diagnosis of PPBC within 10 years post partum appears to be associated with an increased risk for metastasis. This increased risk was highest in stages I and II cancer at diagnosis and present in both patients with estrogen receptor–positive and estrogen receptor–negative cancer, persisting in estrogen receptor–positive cases for up to 15 years after diagnosis. Postpartum breast cancer diagnoses were not associated with increased Ki67 index but were associated with increased lymphovascular invasion and lymph node involvement compared with breast cancer in nulliparous patients. This cohort study evaluates the risk of metastasis following a postpartum breast cancer diagnosis and clinical factors associated with this risk in women 45 years or younger.
- Subjects
COLORADO; BREAST cancer diagnosis; PUERPERIUM; BREAST cancer; METASTASIS; CANCER risk factors; CANCER prognosis; BREAST tumor diagnosis; RISK of metastasis; ANALYSIS of variance; CHI-squared test; FISHER exact test; MEDICAL cooperation; RESEARCH; RESEARCH funding; RISK assessment; WOMEN'S health; PROPORTIONAL hazards models; DATA analysis software; DESCRIPTIVE statistics; KAPLAN-Meier estimator; LOG-rank test; KRUSKAL-Wallis Test
- Publication
JAMA Network Open, 2019, Vol 2, Issue 1, pe186997
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2018.6997