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Pre-diagnostic breastfeeding, adiposity, and mortality among parous Hispanic and non-Hispanic white women with invasive breast cancer: the Breast Cancer Health Disparities Study

  • Epidemiology
  • Published:
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Abstract

Background

U.S. Hispanic women have high rates of parity, breastfeeding, and obesity. It is unclear whether these reproductive factors are associated with breast cancer (BC) mortality. We examined the associations between breastfeeding, parity, adiposity and BC-specific and overall mortality in Hispanic and non-Hispanic white (NHW) BC cases.

Methods

The study population included 2921 parous women (1477 Hispanics, 1444 NHWs) from the Breast Cancer Health Disparities Study with invasive BC diagnosed between 1995 and 2004. Information on reproductive history and lifestyle factors was collected by in-person interview. Overall and stratified Cox proportional hazard regression models by ethnicity, parity, and body mass index (BMI) at age 30 years were used to calculate hazard ratios (HR) and 95% confidence intervals (CI).

Results

After a median follow-up time of 11.2 years, a total of 679 deaths occurred. Pre-diagnostic breastfeeding was associated with a 16% reduction in mortality (HR 0.84; 95% 0.72–0.99) irrespective of ethnicity. Parity significantly modified the association between breastfeeding duration and mortality (p interaction = 0.05), with longer breastfeeding duration associated with lower risk among women who had ≤2 births (p trend = 0.02). Breastfeeding duration was associated with reduced risk of both BC-specific and overall mortality among women with BMI <25 kg/m2, while positive associations were observed among women with BMI ≥25 kg/m2 (p interactions <0.01).

Conclusion

Pre-diagnostic breastfeeding was inversely associated with risk of mortality after BC, particularly in women of low parity or normal BMI. These results provide another reason to encourage breastfeeding and weight management among young women.

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Acknowledgements

We would like to acknowledge the contributions of the following individuals to the study: Jennifer Herrick and Sandra Edwards for data harmonization oversight; Jocelyn Koo for data management for the San Francisco Bay Area Breast Cancer Study; and Dr. Tim Byers and Dr. Anna R. Giuliano for their contributions to the 4-Corners Breast Cancer Study.

Funding

The work was supported by grant CA14002 from the National Cancer Institute. The San Francisco Bay Area Breast Cancer Study was supported by Grants CA63446 and CA77305 from the National Cancer Institute, Grant DAMD17-96-1-6071 from the U.S. Department of Defense, and Grant 7 PB-0068 from the California Breast Cancer Research Program. The collection of cancer incidence data used in this study was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under contract HHSN261201000036C awarded to the Cancer Prevention Institute of California; and the Centers for Disease Control and Prevention’s National Program of Cancer Registries, under agreement #1U58 DP000807-01 awarded to the Public Health Institute. The 4-Corners Breast Cancer Study was funded by Grants CA078682, CA078762, CA078552, and CA078802 from the National Cancer Institute. The research also was supported by the Utah Cancer Registry, which is funded by contract N01-PC-67000 from the National Cancer Institute, with additional support from the State of Utah Department of Health, the New Mexico Tumor Registry, and the Arizona and Colorado cancer registries, funded by the Centers for Disease Control and Prevention National Program of Cancer Registries and additional state support. The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official view of the National Cancer Institute or endorsement by the State of California Department of Public Health, the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors.

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Authors and Affiliations

  1. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Office E-6137, Baltimore, MD, 21205, USA

    Avonne E. Connor & Kala Visvanathan

  2. Department of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA

    Avonne E. Connor & Kala Visvanathan

  3. Department of Epidemiology and Population Health; James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA

    Kathy B. Baumgartner, Richard N. Baumgartner & Stephanie D. Boone

  4. Department of Biology, University of Colorado, Colorado Springs, Colorado Springs, CO, USA

    Lisa M. Hines

  5. Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA

    Roger K. Wolff & Martha L. Slattery

  6. Cancer Prevention Institute of California, Fremont, CA, USA

    Esther M. John

  7. Department of Health Research and Policy (Epidemiology), and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA

    Esther M. John

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  1. Avonne E. Connor
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  2. Kala Visvanathan
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  4. Richard N. Baumgartner
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  5. Stephanie D. Boone
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  9. Martha L. Slattery
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Correspondence to Avonne E. Connor.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Connor, A.E., Visvanathan, K., Baumgartner, K.B. et al. Pre-diagnostic breastfeeding, adiposity, and mortality among parous Hispanic and non-Hispanic white women with invasive breast cancer: the Breast Cancer Health Disparities Study. Breast Cancer Res Treat 161, 321–331 (2017). https://doi.org/10.1007/s10549-016-4048-9

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