The impact of reproductive life on breast cancer risk in women with family history or BRCA mutation

Abstract

Reproductive history and exogenous hormonal exposures are acknowledged risk factors for breast cancer in the general population. In women at increased breast cancer risk for genetic predisposition or positive family history, data regarding these risk factors are limited or conflicting, and recommendations for these categories are unclear. We evaluated the characteristics of reproductive life in 2522 women at increased genetic or familial breast cancer risk attending our Family Cancer Center. Breast cancers in BRCA mutation carriers were more likely to be hormone receptor negative, diagnosed at 35 years or before and multiple during the lifetime than tumors in women at increased familial risk, while the distribution of invasive cancers and HER2 positive tumors was similar in the different risk groups. At least one full-term pregnancy (HR 0.27; 95% CI 0.12–0.58; p = 0.001), breastfeeding either less (HR 0.24; 95% CI 0.09–0.66; p = 0.005) or more (HR 0.25; 95% IC 0.08–0.82; p = 0.022) than one year and late age at menopause (HR 0.10; 95% CI 0.01–0.82; p = 0.033) showed to be protective factors in BRCA mutation carriers, while in women at increased familial risk early age at first full-term pregnancy (HR 0.62; 95% IC 0.38–0.99; p = 0.048) and late menarche (HR 0.61; 95% CI 0.42–0.85; p = 0.004) showed to be the main protective factors. Finally, for the entire population, combined hormonal contraceptives demonstrated to do not increase breast cancer risk. The results of our study suggest that women at high familial risk and mutation carries develop tumors with different clinical-pathological characteristics and, consequently, are influenced by different protective and risk factors.

Effect of Family History on Clinical and Pathological Characteristics of Breast Cancer: a Hospital-Based Study in Egypt

“…This is supported by Lambertini et al study (17) which confirmed the protective effect of ever breastfeeding against hormone receptor-negative breast cancer, which is more common in younger women. Also, Toss et al (18) found a protective effect of breastfeeding only in triple negative breast cancer which represent only 15% of breast cancer cases and this explains the results of the present study which found that breastfeeding had no protective effect against familial breast cancer.…”

“…The same finding was reported by results of several studies. (17,18,20) Horn et al (21) explained this finding by the fact that familial breast cancer is more frequently hormone receptor negative tumors, while age at menarche, age at first delivery and parity seems to modify mostly the incidence of hormone receptor-positive tumors.…”

Tumour growth and immune evasion as targets for a new strategy in advanced cancer

“…Despite the availability of new biological drugs and a more rational use of therapies, the clinical outcome remains poor. Thus, the life expectancy of patients with advanced disease is dismal, and the median survival of a mixed population of metastatic breast cancer patients has not substantially improved in the last decades (Chia et al 2007, Dawood et al 2008, Welt et al 2016, Toss et al 2017.…”

A Translational Study of a Silicon Phthalocyanine Substituted with a Histone Deacetylase Inhibitor for Photodynamic Therapy

“…Various factors play a role in breast cancer mutagenesis including gene mutations, prolonged endogenous and exogenous estrogen exposure, and family history. 32 Despite the advancements in cancer management, therapies that increase the survival rate while improving life quality of patients are still required. 33 As it avoids systemic adverse effects by exerting a local response and being capable of initiating antitumor immunity, PDT may be an attractive option for breast cancer treatment; both alone and in combination with other procedures.…”