Breast cancer diagnosed in the post-weaning period is indicative for a poor outcome

Lefrère, Hanne; Floris, Giuseppe; Schmidt, Marjanka K.; Neven, Patrick; Cardonick, Elyce; Peccatori, Fedro Alessandro; Loibl, Sibylle; Maggen, Charlotte; Mulder, Hanne De; Jerzak, Katarzyna J.; Lambrechts, Diether; Lenaerts, Liesbeth; Amant, Frédéric

doi:10.1016/j.ejca.2021.06.009

Cited by 10 publications

(6 citation statements)

References 42 publications

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“…In terms of risk of breast cancer, postpartum breast cancer is sometimes defined on the basis that the incidence rate temporarily increases for up to 5 years after delivery, and thereafter there is no difference from the incidence rate of the general population. In terms of prognosis, postpartum breast cancer is also defined on the basis that the prognosis of breast cancer that occurs within a certain period after delivery is different from that of breast cancer that occurs later (23).…”

Section: Introductionmentioning

confidence: 99%

The Risk Factors, Incidence and Prognosis of Postpartum Breast Cancer: A Nationwide Study by the SMARTSHIP Group

Park

Lee²,

Yoon³

et al. 2022

Front. Oncol.

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The term ‘pregnancy-associated breast cancer’ is no longer used as it has been consistently reported that breast cancer during pregnancy and breast cancer after delivery (postpartum breast cancer) have different characteristics and prognosis. The purpose of this study is to define postpartum breast cancer by analyzing the incidence rate, related factors, and prognosis according to the timing of breast cancer. Data from the Korean National Health Insurance Service were used to analyze 1,292,727 women aged 20-49 years who birthed their first child between 2007 and 2012. The annual incidence rate of breast cancer after delivery increased every year (7.7 per 10,000 person-years after 5 years, 19.36 per 10,000 person-years after 10 years). The risk of breast cancer was significantly higher (hazard ratio 1.15, 95% CI 1.05-1.27, P=0.0037) in women diagnosed with gestational diabetes, but that was not associated with overall survival (OS). Patients diagnosed with breast cancer within 5 years of delivery had a poorer prognosis than those diagnosed later (5-year OS, <5 years: 91.1% vs. 5-10 years: 96.0%). In multivariate analysis of OS, the hazard ratio of patients diagnosed within 5 years after delivery was twice as high as of patients diagnosed between 5 and 10 years. Women diagnosed with gestational diabetes had an increased risk of breast cancer. Breast cancer patients diagnosed within 5 years of delivery had a poorer prognosis than those diagnosed later. In this regard, careful screening for early diagnosis of high-risk patients and intensive research on new treatment strategies are needed.

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Section: Introductionmentioning

confidence: 99%

The Risk Factors, Incidence and Prognosis of Postpartum Breast Cancer: A Nationwide Study by the SMARTSHIP Group

Park

Lee²,

Yoon³

et al. 2022

Front. Oncol.

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“…In this study, we investigated previously reported changes in liver remodeling during a lactation-wean cycle, through the exploration of gene expression changes. Previous findings highlight that liver involution has implications in metastatic spread of breast cancer 6,31 , yet liver alterations during a reproductive cycle could have larger implications for liver health and diseases. In our study, we identified lactation as a period of increased liver proliferation and anabolic metabolism.…”

Section: Discussionmentioning

confidence: 99%

“…In the liver, similar stromal changes are known to associate with several liver pathologies including liver cirrhosis 24 , fatty liver disease 25,26 , autoimmune hepatitis 27 , and cancer 28,29 . Of potential relevance to cancer, weaning-induced involution of the breast and liver is associated with breast cancer promotion and increased liver metastasis in both rodent models 6,8 and women [30][31][32] . In sum, these prior findings implicate postpartum liver remodeling as a potential mediator of liver pathologies in recently pregnant women.…”

Section: Introductionmentioning

confidence: 99%

Reproductive state controls transcription in the murine liver, with implications for breast cancer liver metastasis

Ozaki,

Zhang,

Bartlett

et al. 2024

Preprint

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Liver biology is functionally linked to lactation, as liver size and metabolic output increase during lactation to support synthesis of breast milk. Upon weaning, the rodent liver returns to baseline homeostasis via hepatocyte cell death, in a process considered liver involution. To explore liver biology changes across a lactation-wean cycle, we employed transcriptomic profiling. We identified elevated hepatocyte proliferation and anabolic metabolism gene signatures during lactation, consistent with the liver being a major producer of substrates needed for milk production. Rapid loss of these capacities upon weaning correlated with catabolic metabolism, lysosomal-mediated cell death, and an influx of immune suppressive cells. Furthermore, we identified that the transcriptional profiles associated with liver involution share similarities with the gene expression patterns of liver pre-metastatic niches. This work identifies features of reproductive control of liver biology that sets a foundation for better understanding the potential role of the liver in maternal health.

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“…From the GBG registry, all patients are younger than 40 years as this is the age limit for recruitment by GBG. Patients with a breast cancer diagnosis within two years after a delivery were excluded for analysis because of the reported inferior survival for postpartum breast cancer cases [1,12].…”

Section: Methodsmentioning

confidence: 99%

Outcome of breast cancer patients treated with chemotherapy during pregnancy compared with non-pregnant controls.

Amant¹,

Nekljudova

Maggen

et al. 2021

JCO

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515 Background: Overall a diagnosis of breast cancer during pregnancy (BCP) appears not to impact maternal prognosis if standard treatment is offered. However, caution is warranted as gestational changes in pharmacokinetics with respect to the distribution, metabolism and excretion of drugs may lead to reduced chemotherapy concentration in pregnant patients. This cohort study was designed to focus on the maternal prognosis of BCP patients that receive chemotherapy during pregnancy. Methods: The outcome of BCP patients treated with chemotherapy during pregnancy was compared to non-pregnant breast cancer patients treated with chemotherapy, diagnosed after 2000, excluding postpartum diagnosis and with an age limit of 45 years. The data was registered by two multicentric registries (the International Network of Cancer, Infertility and Pregnancy and the German Breast Cancer Group) that collect both retro-and prospectively breast cancer data. Cox proportional hazards regression was used to compare disease-free (DFS) and overall survival (OS) between both groups, adjusting for age, stage, grade, hormone receptor status, human epidermal growth factor 2 status and histology, weighted by propensity scoring in order to account for the differences in baseline characteristics between pregnant patients and controls. Results: In total, 662 pregnant and 2081 non-pregnant patients, were eligible for analysis. Median age at diagnosis was 34 (range 22-47) years for pregnant and 38 (range 19-45) years for non-pregnant patients. Pregnant patients were more likely to have stage II breast cancer (60.1% vs 56.1%, p = 0.035), grade 3 tumors (74.0% vs 62.2%, p < 0.001), hormone receptor-negative tumors (48.4% vs 34.0%, p < 0.001) or triple-negative breast cancer (38.9% vs 26.9%, p < 0.001). Median follow-up was 66 months. DFS and OS were comparable for pregnant and non-pregnant patients (DFS: HR 1.02, 95%CI 0.82-1.27, p = 0.83; OS: HR 1.08, 95% CI 0.81-1.45, p = 0.59). A subgroup analysis of 339 women that received more than 60% of chemotherapy during pregnancy (cut-off at median) revealed a comparable survival compared to non-pregnant women (DFS: HR 0.81, 95%CI 0.62-1.06, p = 0.13; OS: HR 0.85 95% CI 0.58-1.23, p = 0.39). Conclusions: Pregnancy-induced alternations in chemotherapy concentration do not seem to affect maternal prognosis in breast cancer patients. These results support initiation of chemotherapy for BCP where indicated for oncological reasons.

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Breast cancer diagnosed in the post-weaning period is indicative for a poor outcome

Cited by 10 publications

References 42 publications

The Risk Factors, Incidence and Prognosis of Postpartum Breast Cancer: A Nationwide Study by the SMARTSHIP Group

The Risk Factors, Incidence and Prognosis of Postpartum Breast Cancer: A Nationwide Study by the SMARTSHIP Group

Reproductive state controls transcription in the murine liver, with implications for breast cancer liver metastasis

Outcome of breast cancer patients treated with chemotherapy during pregnancy compared with non-pregnant controls.

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