Preeclampsia and breast cancer: The influence of birth characteristics

Pacheco, Nadja Livia Pekkola; Andersen, Anne‐Marie Nybo; Kamper-Jørgensen, Mads

doi:10.1016/j.breast.2015.06.006

Cited by 26 publications

(50 citation statements)

References 36 publications

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“…The literature on breast cancer risk in women with a history of preeclampsia is inconsistent. Some studies have reported an inverse association, one a positive association and others, including meta‐analyses, reported no association . Only two studies, both of case–control design, investigated the association between preeclampsia history and breast cancer by menopausal status, with one reporting a decreased risk of postmenopausal but not premenopausal breast cancer and the other no association in either group, contrary to our findings of a reduced risk of premenopausal but not postmenopausal breast cancer.…”

Section: Discussioncontrasting

confidence: 99%

“…Only two studies, both of case–control design, investigated the association between preeclampsia history and breast cancer by menopausal status, with one reporting a decreased risk of postmenopausal but not premenopausal breast cancer and the other no association in either group, contrary to our findings of a reduced risk of premenopausal but not postmenopausal breast cancer. One study investigated if the association may depend on age at preeclamptic pregnancy, finding no association, similar to our findings. We did not observe that the associations differed between invasive and in situ breast cancer, in accord with the only previous study that analysed this .…”

Section: Discussionsupporting

confidence: 88%

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Breast cancer risk in relation to history of preeclampsia and hyperemesis gravidarum: Prospective analysis in the Generations Study

Wright

Schoemaker

Jones

et al. 2018

Intl Journal of Cancer

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Preeclampsia and hyperemesis gravidarum are pregnancy complications associated with altered sex hormone levels. Previous studies suggest preeclampsia may be associated with a decreased risk of subsequent breast cancer and hyperemesis with an increased risk, but the evidence remains unclear. We used data from the Generations Study, a large prospective study of women in the United Kingdom, to estimate relative risks of breast cancer in relation to a history of preeclampsia and hyperemesis using Cox regression adjusting for known breast cancer risk factors. During 7.5 years average follow‐up of 82,053 parous women, 1,969 were diagnosed with invasive or in situ breast cancer. Women who had experienced preeclampsia during pregnancy had a significantly decreased risk of premenopausal breast cancer (hazard ratio (HR) =0.67, 95% confidence interval (CI): 0.49–0.90) and of HER2‐enriched tumours (HR = 0.33, 95% CI: 0.12–0.91), but there was no association with overall (HR = 0.90, 95% CI: 0.80–1.02) or postmenopausal (HR = 0.97, 95% CI: 0.85–1.12) breast cancer risk. Risk reductions among premenopausal women were strongest within 20 years since the last pregnancy with preeclampsia. Hyperemesis was associated with a significantly increased risk of HER2‐enriched tumours (HR = 1.76, 95% CI: 1.07–2.87), but not with other intrinsic subtypes or breast cancer risk overall. These results provide evidence that preeclampsia is associated with a decreased risk of premenopausal and HER2‐enriched breast cancer and that hyperemesis, although not associated with breast cancer risk overall, may be associated with raised risk of HER2‐enriched tumours.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 88%

Breast cancer risk in relation to history of preeclampsia and hyperemesis gravidarum: Prospective analysis in the Generations Study

Wright

Schoemaker

Jones

et al. 2018

Intl Journal of Cancer

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“…No previous study has investigated the risk only of solid cancers. However, previous studies have suggested the possibility that a history of preeclampsia might be associated with a reduced risk of certain specific solid cancers, most notably breast cancer . We found no association between a history of HDP and most individual solid cancers.…”

Section: Discussioncontrasting

confidence: 74%

“…The angiogenic imbalance observed in preeclampsia has been hypothesized to play a role in the reduced risk of breast cancer in women with a history of HDP . However, if the angiogenic imbalance in these women was strong enough to reduce their later risk of breast cancer, one would expect to see reduced risks of other solid cancers as well, which we did not.…”

Section: Discussionmentioning

confidence: 55%

Hypertensive disorders of pregnancy and subsequent risk of solid cancer—A nationwide cohort study

Behrens

Basit

Jensen

et al. 2016

Intl Journal of Cancer

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Women with hypertensive disorders of pregnancy (HDP) have higher levels of antiangiogenic growth factors during pregnancy than women with normotensive pregnancies. Since angiogenesis is necessary for solid cancer growth and spread, we hypothesized that women with a history of HDP might have a reduced risk of solid cancers (cancers other than lymphomas, hematologic cancers and nonmelanoma skin cancers) later in life. In a register-based cohort study of 1.08 million women giving birth at least once between 1978 and 2011, we used Cox regression to estimate hazard ratios (HRs) comparing solid cancer rates for women with and without a history of HDP. In this cohort, 68,236 women (6.3%) had 1 pregnancy complicated by HDP and 42,236 women (3.9%) developed solid tumors during follow-up. A history of HDP was not associated with a clinically meaningful reduction in the overall rate of solid cancer (HR 0.96, 95% confidence interval 0.92-1.00), regardless of HDP severity or time since HDP, nor was there a general tendency toward reduced solid cancer rates across organ sites. A history of HDP was only significantly associated with decreased rates of breast and lung cancers and with increased rates of endometrial and urinary tract cancers. Overall, our results do not support the hypothesis that women with a history of HDP have a reduced overall risk of solid cancer due to a persistent post-HDP antiangiogenic state or an innate tendency toward antiangiogenesis. Observed associations with specific cancers may instead be due to other pregnancy-related mechanisms or to residual/unmeasured confounding.Hypertensive disorders of pregnancy (HDP) are a group of disorders that affect up to 10% of pregnancies worldwide; the preeclampsia syndrome alone complicates 2-8% of pregnancies.1,2 While the various disorders classified as HDP share clinical features, their etiology is unclear, and although pathophysiologic pathways may overlap, there is likely etiologic heterogeneity.A balance between proangiogenic factors (e.g., vascular endothelial growth factor [VEGF], placental growth factor [PlGF]) and antiangiogenic factors (e.g., soluble fms-like tyrosine kinase-1 [sFlt1] and soluble endoglin [sEng]) is required to maintain vascular endothelial function. An imbalance toward antiangiogenesis likely contributes to the symptoms of preeclampsia 3 ; antiangiogenic factor levels rise earlier and reach higher levels in preeclamptic pregnancies (particularly in early-onset, severe preeclampsia) than in normal pregnancies. [4][5][6][7][8] However, whether the antiangiogenic imbalance in these women is pregnancyinduced, or women who develop preeclampsia have an innate tendency to antiangiogenesis, is unclear. Angiogenesis is also necessary for the growth and spread of solid cancers 10

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“…Preeclampsia is a pregnancy-associated condition linked with GDM that may be associated with lower breast cancer risk. (28, 29) However, adjusting for a history of pregnancy-induced hypertension did not impact our findings.…”

Section: Discussionmentioning

confidence: 52%

History of Gestational Diabetes Mellitus and Risk of Incident Invasive Breast Cancer among Parous Women in the Nurses' Health Study II Prospective Cohort

Powe

Tobias

Michels

et al. 2017

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background Type 2 diabetes is associated with breast cancer in epidemiologic studies. Pregnancy also modifies breast cancer risk. We hypothesized that women with a history of gestational diabetes mellitus (GDM), which shares pathogenesis and risk factors with type 2 diabetes, would have greater invasive breast cancer risk than parous women without a history of GDM. Methods We conducted a prospective analysis among parous women in the Nurses' Health Study II, with mean age 35 years in 1989. Multivariate Cox proportional hazard models were used to compare risks of incident invasive breast cancer in women with and without a history of GDM. Results Among 86,972 women studied, 5,188 women reported a history of GDM and 2,377 developed invasive breast cancer (100 with history of GDM, 2277 without GDM) over 22 years of prospective follow-up. History of GDM was inversely associated with incident invasive breast cancer (HR 0.68, 95% CI 0.55-0.84, p=0.0004), compared with no history of GDM, after adjustment for body mass index, reproductive history, and other breast cancer risk factors. Findings were similar by menopausal status, although observed person-time was predominantly premenopausal (premenopausal: HR 0.73, 95% CI 0.56-0.96, p=0.03; postmenopausal: HR 0.63, 95% CI 0.43-0.92, p=0.02). Restricting to women undergoing mammography screening modestly attenuated the relationship (HR 0.74, 95% CI 0.57-0.96, p=0.02). Conclusion Among a large cohort of US women, history of GDM was not associated with an elevated risk of subsequent invasive breast cancer. Impact Our findings highlight the need to further investigate GDM's role in breast cancer development.

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Preeclampsia and breast cancer: The influence of birth characteristics

Cited by 26 publications

References 36 publications

Breast cancer risk in relation to history of preeclampsia and hyperemesis gravidarum: Prospective analysis in the Generations Study

Breast cancer risk in relation to history of preeclampsia and hyperemesis gravidarum: Prospective analysis in the Generations Study

Hypertensive disorders of pregnancy and subsequent risk of solid cancer—A nationwide cohort study

History of Gestational Diabetes Mellitus and Risk of Incident Invasive Breast Cancer among Parous Women in the Nurses' Health Study II Prospective Cohort

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