Breast Cancer Up to 5 Times More Likely to Metastasise Even 10 Years After Childbirth

Breast cancers diagnosed in young women within 10 years of giving birth are more likely to metastasise, and thus more likely to cause death, than breast cancers in young women who gave birth less recently or not at all, according to a study published in JAMA Network.

“This is the first study to demonstrate that a postpartum breast cancer diagnosed up to 10 years after last childbirth can independently increase a woman’s risk for developing metastasis to other parts of the body,” said Virginia Borges, MD, University of Colorado Cancer Center, Aurora, Colorado.

The researchers analysed the data of 701 female patients with breast cancer aged 45 years and younger included in the Colorado Young Women’s Breast Cancer Cohort. The researchers compared the risk for developing distant metastases among 3 groups: women who had never had a child, women who had their last childbirth within the past 10 years, and women with children born more than 10 years prior to their diagnosis. This risk for developing metastases in these groups was also evaluated across well-known breast cancer risk features.

The increased risk for metastasis was highest in the women up to 10 years postpartum and was most pronounced in women with stage I or II breast cancer, with a 3.5-to-5 times higher risk than women with similar, non-pregnancy associated cancers.

For oestrogen receptor (ER)-positive tumours, increased risk of metastasis was present up to 15 years post-diagnosis, approaching the level of metastasis risk associated with dangerous forms of breast cancer including ER-negative and triple-negative breast cancers.

“In these cancers, the tumours themselves do not appear different,” said Dr. Borges. “There’s no difference in the percent that are more aggressive subtypes, such as triple-negative or HER2, no difference in the stage at which they are diagnosed, or other differences in classic measures that you might think would increase the chance of a bad prognosis. Instead, these data support previous findings from our team’s lab work showing that after childbirth, conditions in surrounding breast tissue may aid the development of metastases. For example, we have shown that the laying down of new lymph channels in breast tissue after childbirth and nursing may allow cancer cells to better travel and seed sites of metastasis. Sure enough, the current work finds more women having cancer in their lymph nodes at diagnosis.”

“These findings highlight the need to understand that postpartum breast cancer may represent a unique subtype of cancer that requires distinct care,” she added. “All women know when they last gave birth, so this is a readily available, free piece of information that helps us identify young women at highest risk from their breast cancer. If we are aware of the increased risk, we can work towards finding the best means to overcome this risk and treat it appropriately.”

Reference: http://dx.doi.org/10.1001/jamanetworkopen.2018.6997

Gestational weight gain is associated with delayed onset of lactogenesis.

A new study published in Clinical Nutrition examined the association between gestational weight gain (GWG) throughout pregnancy and risk of delayed onset of lactogenesis II (OL). This study utilized data from a prospective cohort study in China, including pregnant women at 8-16 weeks of gestation who were regularly followed-up. GWG was assessed by the last available weight measurement during pregnancy and the self-reported pre-pregnancy weight at enrollment. The outcome was delayed OL self-reported after 4 days postpartum. The results revealed that delayed OL was reported by 18.4% of the 3,282 participants. From the results, it was concluded that women with higher GWG throughout pregnancy are more likely to suffer from delayed OL.

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Preventive therapy for Breast Cancer

A targeted performance improvement program increased the rate at which physicians and other health care providers recommended the use of antiestrogen preventive therapy for women with atypical hyperplasia (AH) and lobular cancer in situ (LCIS), according to the results of a single-center study.¹

Preventive therapy using the selective estrogen-receptor modulators (SERMs), tamoxifen and raloxifene, or an aromatase inhibitor is recommended for all women at high risk of developing breast cancer; these treatments are strongly recommended in women with AH and LCIS. Women with AH/LCIS can reduce their risk for breast cancer by as much as 75% with these medications, but fewer than 30% of them take advantage, primarily because of lack of provider recommendation or concern about side effects.

 “One of the reasons why there is very low uptake reported in the literature is that these drugs that are used for prevention are also used to treat women with breast cancer,” explained study researcher Abenaa M. Brewster, MD, professor of clinical cancer prevention at the University of Texas MD Anderson Cancer Center in Houston. “In addition, generally primary care doctors are the ones primarily seeing women at increased risk and are not very familiar with these drugs. Because of this lack of familiarity there is reluctance to recommend treatment.”

For this study, Dr Brewster and colleagues implemented a performance improvement program designed to increase uptake of these preventive therapies in practices throughout the MD Anderson Cancer Prevention Center and in satellite clinics. From November 2015 to February 2017, patients with AH or LCIS were screened prior to their clinic appointment to determine eligibility. Providers were then alerted to their patients registered on the program.

“We performed some education, detailing how strongly these medications work in these patients to reduce the risk of developing breast cancer, and taught them methods for giving strong recommendations,” Dr Brewster told Cancer Therapy Advisor.

After the visit, providers and patients were asked to complete a survey rating the strength of the recommendation for preventive therapy on a scale from 1 to 5.

 Source: https://www.cancertherapyadvisor.com