Women diagnosed with breast cancer within 12 months after completingd a pregnancy are 48% more likely to die than other young women with breast cancer according research presented at the seventh European Breast Cancer Conference (EBCC7) in Barcelona.

However, if the breast cancer was diagnosed while the women were pregnant, the mortality their mortality risk was nearly the same, just three percent higher, as non-pregnant women diagnosed with breast cancer according to two separate studies.

One study of 2,752 breast cancer patients found that suggest that the cumulative effect of pregnancy, and breast feeding  in breast cancer prognosis needs further investigation said Assistant Professor Angela Ives, research fellow at The University of Western Australia,

Because very little is known about gestational breast cancer she and her colleagues decided to find out more so that women could make informed choices about their breast cancer management and pregnancy outcome.

Gestational breast cancer is  a cancer that is diagnosed while a woman is pregnant or up to 12 months after completion

The study group of 2,752 Western Australian women, aged less than 45 were identified using the Western Australia Data Linkage System. All diagnosed with breast cancer between January 1982 and December 2003.

The study followed them to December 2007 or to their date of death, if earlier.
The WA Data Linkage System is one of only five comprehensive record linkage systems in the world” she said. “It brings together population-based hospital morbidity data, birth and death records, mental health services data, cancer registrations and midwives’ notifications, linked back to 1980.”

“It is important to stress that our findings should not discourage women from breast feeding as we know that this is beneficial to both mother and baby in a number of ways” she said.

“While most breast symptoms or abnormalities identified in young women are benign, it is important that when a woman is pregnant or breast feeding any symptoms or abnormalities are not assumed to be due to the pregnancy or breast feeding” she said

Particularly if the symptoms persist.

It is important that both health professionals and young women are breast aware, even during pregnancy and breast-feeding, and promptly have symptoms investigated to allow early diagnosis.

“For women who are diagnosed with breast cancer after pregnancy, they and their clinicians may wish to consider different forms of treatment to improve survival.”

The researchers considered additional factors such as age at diagnosis, histological tumour grade, stage of disease and whether the cancer had spread to the lymph nodes.

From the total number of women, 182 were diagnosed with gestational breast cancer, 55 while they were pregnant and 127 after the end of the pregnancy.

Histological tumour grade, disease stage and lymph node involvement were all associated with a worse survival for all the women.

However, the increased risk of death if breast cancer was diagnosed after pregnancy remained even after adjusting for lymph node status, disease stage at diagnosis, histological tumour grade and age.

“It has been assumed over many years that actually being pregnant at diagnosis led to poor survival” she said ‘but this study has shown that it might be the amount of time that a woman is pregnant and her body’s responses to being pregnant that encourage the growth of a breast cancer.”

It is also possible that the changes in the breast while pregnant and then breast feeding may mask a breast cancer, she said, resulting in a more advanced cancer at diagnosis.

“We do know that pregnancy and breast-feeding reduce the long-term risk of a woman developing breast cancer, but we also know that, in the short term, having been pregnant may increase the risk of developing breast cancer.”

Further research is required and professor Ives team is now investigating what might be happening at cell level with the way tumours grow (angiogenesis) and the role played by the body’s immune response.

In a second study, Dr Salma Butt from the Department of Surgery, Malmö University Hospital, Sweden examined the link between the length of time that women breast-fed and the different types of breast cancer they subsequently developed.

While the risk of developing breast cancer was the same regardless of the duration of breast-feeding, women who had breast-fed for six months or longer had a statistically significant risk of developing more aggressive types of breast cancer, she said.

However, they do not know if means these women are more likely to die from their cancer.

Previous studies investigated the association between breast-feeding and breast cancer risk no studies have investigated breast-feeding and risk associated with different types of breast cancer, she said.

No study has investigated the association between breastfeeding, types of breast cancer and survival.

“Our findings need be followed by studies on survival to see if these more aggressive breast tumours actually lead to a higher death rate or not” she said, “because we do know that breast cancers that do not have aggressive characteristics can also have high rates of mortality if they are diagnosed late.”
They examined data collected from a group of 17,035 women in The Malmö Diet and Cancer Study. Then evaluated 622 cases of breast cancer for a range of factors that indicated how aggressive the tumours were.

For example , they considered  invasiveness, tumour size, axillary lymph node status, HER2 status, Ki67, which is an indicator for tumour proliferation.

They analysed the duration of breast feeding for each child, total amount of time a woman had breast-fed, and the average time of breast-feeding per child.

The average duration of breast feeding was divided into four groups: less than 2.2 months, less than four months, four months or more, and 6.2 months or more.

“We found a statistically significant risk of grade III tumours in women with an average time of breast-feeding of 6.2 months or more” Dr Butt said:. “The risk of tumours expressing higher levels of Ki67 was also significantly associated with longer duration of breast-feeding.”

“ We concluded that long duration of breast-feeding was associated with more unfavourable types of breast cancer.”

This should not discourage women from breast-feeding as several strong studies show that breast-feeding could reduce a woman’s overall risk of breast cancer, and that longer breast-feeding times were good for both mother and baby.

“The most important thing would be to identify women with a higher risk of aggressive types of breast cancer and offer them intensified screening, in order to identify their tumours early.”

Because the study was an epidemiological it could show risk associations but not causes, she said.

“The biological mechanisms behind this are still to be identified. What is known is that breast-feeding reduces the number of ovulatory menstrual cycles over a lifetime, thereby reducing the impact of hormone levels present during normal menstrual cycles and, in particular, reducing the progesterone exposure.”

“This may explain the finding in previous studies of a reduced risk of breast cancer in women who had breast-fed” She said.

“Breast-feeding stimulates the production of prolactin, a hormone that has been reported to have tumour-promoting effects. But the relation between breastfeeding, prolactin and breast cancer is complex and not fully understood.”

Source: Adapted from Emma Mason ECCO-the European CanCer Organisation