Lactation and a Reduced Risk of Premenopausal Breast Cancer
Polly A. Newcomb, Barry E. Storer, Matthew P. Longnecker, Robert Mittendorf, E. Robert Greenberg, Richard W. Clapp, Kenneth P. Burke, Walter C. Willett, and Brian MacMahon
Background The evidence of an association of lactation witha reduction in the risk of breast cancer among women has beenlimited and inconsistent. The effect of lactation appears tobe confined to premenopausal women with a history of long lactation,but most studies of this relation have been limited in statisticalpower. We conducted a multicenter, population-based, case-controlstudy with a sample large enough for us to describe more preciselythe association between lactation and the risk of breast cancer.
Methods Patients less than 75 years old who had breast cancerwere identified from statewide tumor registries in Wisconsin,Massachusetts, Maine, and New Hampshire. Controls were randomlyselected from lists of licensed drivers if the case subjectswere less than 65 years old, and from lists of Medicare beneficiariesif they were 65 through 74 years old. Information on lactation,reproductive history, and family and medical history was obtainedby means of telephone interviews. After the exclusion of nulliparouswomen, 5878 case subjects and 8216 controls remained for analysis.
Results After adjustment for parity, age at first delivery,and other risk factors for breast cancer, lactation was associatedwith a slight reduction in the risk of breast cancer among premenopausalwomen, as compared with the risk among women who were parousbut had never lactated (relative risk, 0.78; 95 percent confidenceinterval, 0.66 to 0.91); the relative risk of breast canceramong postmenopausal women who had lactated, as compared withthose who had not, was 1.04 (95 percent confidence interval,0.95 to 1.14). With an increasing cumulative duration of lactation,there was a decreasing risk of breast cancer among premenopausalwomen (P for trend <0.001) but not among postmenopausal,parous women (P for trend = 0.51). A younger age at first lactationwas significantly associated with a reduction in the risk ofpremenopausal breast cancer (P for trend = 0.003). As comparedwith parous women who did not lactate, the relative risk ofbreast cancer among women who first lactated at less than 20years of age and breast-fed their infants for a total of sixmonths was 0.54 (95 percent confidence interval, 0.36 to 0.82).
Conclusions There is a reduction in the risk of breast canceramong premenopausal women who have lactated. No reduction inthe risk of breast cancer occurred among postmenopausal womenwith a history of lactation.
Source Information
From the University of Wisconsin Comprehensive Cancer Center, Madison, (P.A.N., B.E.S.); the Department of Epidemiology, UCLA School of Public Health, Los Angeles (M.P.L.); the Department of Obstetrics and Gynecology, Pritzker School of Medicine, University of Chicago, Chicago (R.M.); the Departments of Community and Family Medicine and Medicine, Dartmouth Medical School, Hanover, N.H. (E.R.G.); the Massachusetts Cancer Registry, Massachusetts Department of Public Health, Boston (R.W.C.); the Division of Disease Control, Maine Bureau of Health, Augusta (K.P.B.); the Departments of Epidemiology (W.C.W., B.M.) and Nutrition (W.C.W.), Harvard School of Public Health, Boston; the Channing Laboratory, Harvard Medical School, Boston (W.C.W.); and the Department of Medicine, Brigham and Women's Hospital, Boston (W.C.W.).
Address reprint requests to Dr. Newcomb at the University of Wisconsin Comprehensive Cancer Center, 1300 University Ave., No. 4780, Madison, WI 53706.
Breast-Feeding and Breast Cancer
London S. J., Mutgi A. B., Fenster D. L., Ross R. K., Yu M. C., Newcomb P. A., Storer B. E., Longnecker M. P.
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N Engl J Med 1994;
330:1682-1684, Jun 9, 1994.
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