Reproductive history and oral contraceptive use in relation to risk of triple-negative breast cancer

Amanda I. Phipps, Rowan T. Chlebowski, Ross Prentice, Anne McTiernan, Jean Wactawski-Wende, Lewis H. Kuller, Lucile L. Adams-Campbell, Dorothy Lane, Marcia L. Stefanick, Mara Vitolins, Geoffrey C. Kabat, Thomas E. Rohan, Christopher I. Li

Research output: Contribution to journalArticle

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Abstract

Background Triple-negative (ie, estrogen receptor [ER], progesterone receptor, and HER2 negative) breast cancer occurs disproportionately among African American women compared with white women and is associated with a worse prognosis than ER-positive (ER+) breast cancer. Hormonally mediated risk factors may be differentially related to risk of triple-negative and ER+ breast cancers. Methods Using data from 155723 women enrolled in the Women's Health Initiative, we assessed associations between reproductive and menstrual history, breastfeeding, oral contraceptive use, and subtype-specific breast cancer risk. We used Cox regression to evaluate associations with triple-negative (N = 307) and ER+ (N = 2610) breast cancers and used partial likelihood methods to test for differences in subtype-specific hazard ratios (HRs). Results Reproductive history was differentially associated with risk of triple-negative and ER+ breast cancers. Nulliparity was associated with decreased risk of triple-negative breast cancer (HR = 0.61, 95% confidence interval [CI] = 0.37 to 0.97) but increased risk of ER+ breast cancer (HR = 1.35, 95% CI = 1.20 to 1.52). Age-adjusted absolute rates of triple-negative breast cancer were 2.71 and 1.54 per 10000 person-years in parous and nulliparous women, respectively; by comparison, rates of ER+ breast cancer were 21.10 and 28.16 per 10000 person-years in the same two groups. Among parous women, the number of births was positively associated with risk of triple-negative disease (HR for three births or more vs one birth = 1.46, 95% CI = 0.82 to 2.63) and inversely associated with risk of ER+ disease (HR = 0.88, 95% CI = 0.74 to 1.04). Ages at menarche and menopause were modestly associated with risk of ER+ but not triple-negative breast cancer; breastfeeding and oral contraceptive use were not associated with either subtype. Conclusion The association between parity and breast cancer risk differs appreciably for ER+ and triple-negative breast cancers. These findings require further confirmation because the biological mechanisms underlying these differences are uncertain.

Original languageEnglish (US)
Pages (from-to)470-477
Number of pages8
JournalJournal of the National Cancer Institute
Volume103
Issue number6
DOIs
StatePublished - Mar 16 2011

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Triple Negative Breast Neoplasms
Reproductive History
Oral Contraceptives
Estrogen Receptors
Breast Neoplasms
Confidence Intervals
Parturition
Parity
Breast Feeding
Menarche
Women's Health
Progesterone Receptors
Menopause
African Americans

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Phipps, A. I., Chlebowski, R. T., Prentice, R., McTiernan, A., Wactawski-Wende, J., Kuller, L. H., ... Li, C. I. (2011). Reproductive history and oral contraceptive use in relation to risk of triple-negative breast cancer. Journal of the National Cancer Institute, 103(6), 470-477. https://doi.org/10.1093/jnci/djr030

Reproductive history and oral contraceptive use in relation to risk of triple-negative breast cancer. / Phipps, Amanda I.; Chlebowski, Rowan T.; Prentice, Ross; McTiernan, Anne; Wactawski-Wende, Jean; Kuller, Lewis H.; Adams-Campbell, Lucile L.; Lane, Dorothy; Stefanick, Marcia L.; Vitolins, Mara; Kabat, Geoffrey C.; Rohan, Thomas E.; Li, Christopher I.

In: Journal of the National Cancer Institute, Vol. 103, No. 6, 16.03.2011, p. 470-477.

Research output: Contribution to journalArticle

Phipps, AI, Chlebowski, RT, Prentice, R, McTiernan, A, Wactawski-Wende, J, Kuller, LH, Adams-Campbell, LL, Lane, D, Stefanick, ML, Vitolins, M, Kabat, GC, Rohan, TE & Li, CI 2011, 'Reproductive history and oral contraceptive use in relation to risk of triple-negative breast cancer', Journal of the National Cancer Institute, vol. 103, no. 6, pp. 470-477. https://doi.org/10.1093/jnci/djr030
Phipps AI, Chlebowski RT, Prentice R, McTiernan A, Wactawski-Wende J, Kuller LH et al. Reproductive history and oral contraceptive use in relation to risk of triple-negative breast cancer. Journal of the National Cancer Institute. 2011 Mar 16;103(6):470-477. https://doi.org/10.1093/jnci/djr030
Phipps, Amanda I. ; Chlebowski, Rowan T. ; Prentice, Ross ; McTiernan, Anne ; Wactawski-Wende, Jean ; Kuller, Lewis H. ; Adams-Campbell, Lucile L. ; Lane, Dorothy ; Stefanick, Marcia L. ; Vitolins, Mara ; Kabat, Geoffrey C. ; Rohan, Thomas E. ; Li, Christopher I. / Reproductive history and oral contraceptive use in relation to risk of triple-negative breast cancer. In: Journal of the National Cancer Institute. 2011 ; Vol. 103, No. 6. pp. 470-477.
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abstract = "Background Triple-negative (ie, estrogen receptor [ER], progesterone receptor, and HER2 negative) breast cancer occurs disproportionately among African American women compared with white women and is associated with a worse prognosis than ER-positive (ER+) breast cancer. Hormonally mediated risk factors may be differentially related to risk of triple-negative and ER+ breast cancers. Methods Using data from 155723 women enrolled in the Women's Health Initiative, we assessed associations between reproductive and menstrual history, breastfeeding, oral contraceptive use, and subtype-specific breast cancer risk. We used Cox regression to evaluate associations with triple-negative (N = 307) and ER+ (N = 2610) breast cancers and used partial likelihood methods to test for differences in subtype-specific hazard ratios (HRs). Results Reproductive history was differentially associated with risk of triple-negative and ER+ breast cancers. Nulliparity was associated with decreased risk of triple-negative breast cancer (HR = 0.61, 95{\%} confidence interval [CI] = 0.37 to 0.97) but increased risk of ER+ breast cancer (HR = 1.35, 95{\%} CI = 1.20 to 1.52). Age-adjusted absolute rates of triple-negative breast cancer were 2.71 and 1.54 per 10000 person-years in parous and nulliparous women, respectively; by comparison, rates of ER+ breast cancer were 21.10 and 28.16 per 10000 person-years in the same two groups. Among parous women, the number of births was positively associated with risk of triple-negative disease (HR for three births or more vs one birth = 1.46, 95{\%} CI = 0.82 to 2.63) and inversely associated with risk of ER+ disease (HR = 0.88, 95{\%} CI = 0.74 to 1.04). Ages at menarche and menopause were modestly associated with risk of ER+ but not triple-negative breast cancer; breastfeeding and oral contraceptive use were not associated with either subtype. Conclusion The association between parity and breast cancer risk differs appreciably for ER+ and triple-negative breast cancers. These findings require further confirmation because the biological mechanisms underlying these differences are uncertain.",
author = "Phipps, {Amanda I.} and Chlebowski, {Rowan T.} and Ross Prentice and Anne McTiernan and Jean Wactawski-Wende and Kuller, {Lewis H.} and Adams-Campbell, {Lucile L.} and Dorothy Lane and Stefanick, {Marcia L.} and Mara Vitolins and Kabat, {Geoffrey C.} and Rohan, {Thomas E.} and Li, {Christopher I.}",
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T1 - Reproductive history and oral contraceptive use in relation to risk of triple-negative breast cancer

AU - Phipps, Amanda I.

AU - Chlebowski, Rowan T.

AU - Prentice, Ross

AU - McTiernan, Anne

AU - Wactawski-Wende, Jean

AU - Kuller, Lewis H.

AU - Adams-Campbell, Lucile L.

AU - Lane, Dorothy

AU - Stefanick, Marcia L.

AU - Vitolins, Mara

AU - Kabat, Geoffrey C.

AU - Rohan, Thomas E.

AU - Li, Christopher I.

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N2 - Background Triple-negative (ie, estrogen receptor [ER], progesterone receptor, and HER2 negative) breast cancer occurs disproportionately among African American women compared with white women and is associated with a worse prognosis than ER-positive (ER+) breast cancer. Hormonally mediated risk factors may be differentially related to risk of triple-negative and ER+ breast cancers. Methods Using data from 155723 women enrolled in the Women's Health Initiative, we assessed associations between reproductive and menstrual history, breastfeeding, oral contraceptive use, and subtype-specific breast cancer risk. We used Cox regression to evaluate associations with triple-negative (N = 307) and ER+ (N = 2610) breast cancers and used partial likelihood methods to test for differences in subtype-specific hazard ratios (HRs). Results Reproductive history was differentially associated with risk of triple-negative and ER+ breast cancers. Nulliparity was associated with decreased risk of triple-negative breast cancer (HR = 0.61, 95% confidence interval [CI] = 0.37 to 0.97) but increased risk of ER+ breast cancer (HR = 1.35, 95% CI = 1.20 to 1.52). Age-adjusted absolute rates of triple-negative breast cancer were 2.71 and 1.54 per 10000 person-years in parous and nulliparous women, respectively; by comparison, rates of ER+ breast cancer were 21.10 and 28.16 per 10000 person-years in the same two groups. Among parous women, the number of births was positively associated with risk of triple-negative disease (HR for three births or more vs one birth = 1.46, 95% CI = 0.82 to 2.63) and inversely associated with risk of ER+ disease (HR = 0.88, 95% CI = 0.74 to 1.04). Ages at menarche and menopause were modestly associated with risk of ER+ but not triple-negative breast cancer; breastfeeding and oral contraceptive use were not associated with either subtype. Conclusion The association between parity and breast cancer risk differs appreciably for ER+ and triple-negative breast cancers. These findings require further confirmation because the biological mechanisms underlying these differences are uncertain.

AB - Background Triple-negative (ie, estrogen receptor [ER], progesterone receptor, and HER2 negative) breast cancer occurs disproportionately among African American women compared with white women and is associated with a worse prognosis than ER-positive (ER+) breast cancer. Hormonally mediated risk factors may be differentially related to risk of triple-negative and ER+ breast cancers. Methods Using data from 155723 women enrolled in the Women's Health Initiative, we assessed associations between reproductive and menstrual history, breastfeeding, oral contraceptive use, and subtype-specific breast cancer risk. We used Cox regression to evaluate associations with triple-negative (N = 307) and ER+ (N = 2610) breast cancers and used partial likelihood methods to test for differences in subtype-specific hazard ratios (HRs). Results Reproductive history was differentially associated with risk of triple-negative and ER+ breast cancers. Nulliparity was associated with decreased risk of triple-negative breast cancer (HR = 0.61, 95% confidence interval [CI] = 0.37 to 0.97) but increased risk of ER+ breast cancer (HR = 1.35, 95% CI = 1.20 to 1.52). Age-adjusted absolute rates of triple-negative breast cancer were 2.71 and 1.54 per 10000 person-years in parous and nulliparous women, respectively; by comparison, rates of ER+ breast cancer were 21.10 and 28.16 per 10000 person-years in the same two groups. Among parous women, the number of births was positively associated with risk of triple-negative disease (HR for three births or more vs one birth = 1.46, 95% CI = 0.82 to 2.63) and inversely associated with risk of ER+ disease (HR = 0.88, 95% CI = 0.74 to 1.04). Ages at menarche and menopause were modestly associated with risk of ER+ but not triple-negative breast cancer; breastfeeding and oral contraceptive use were not associated with either subtype. Conclusion The association between parity and breast cancer risk differs appreciably for ER+ and triple-negative breast cancers. These findings require further confirmation because the biological mechanisms underlying these differences are uncertain.

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