Susan G Komen  
I've Been Diagnosed With Breast Cancer Someone I Know Was Diagnosed Share Your Story Join Us And Stay Informed Donate To End Breast Cancer
    Home > Research & Grants > Grants Program > Research Grants > Research Grants Awarded > Abstract
    Awarded Grants
    Reproduction, oral contraceptives & Breast Cancer Survival in Young Women

    Scientific Abstract:
    Title: Reproduction, oral contraceptives & breast cancer survival in young women TECHNICAL ABSTRACT Background: In the U.S, an estimated 40,000 women will die of breast cancer in 2003. While 5- year survival rates from breast cancer have been improving, there are groups of women (e.g. younger women) who are known to have a worse prognosis. While much is known about clinical factors (e.g. tumor characteristics, molecular markers) and survival, little is known about the impact of non-clinical factors on survival. Biologically plausible factors may determine a woman’s likelihood of surviving breast cancer, including reproductive factors (age at menarche, number and timing of pregnancies relative to diagnosis, previous use of oral contraceptives etc.). A handful of epidemiological and clinical studies have found reproductive factors to be prognostically important. Given the important role reproductive factors (as proxies for estrogen levels) play in the development of breast cancer, and several lines of indirect evidence for a role of estrogen in determining survival, it is plausible to assume these same factors may have a role in affecting prognosis. Previous studies of various factors have been inconsistent, but have suffered from several shortcomings, including limited power (especially among younger women) and not utilizing population-based samples. Objective/Hypothesis: Various characteristics of women’s reproductive lives may influence the course of breast cancer after it has been diagnosed, potentially in ways that differ from effects on incidence. For example, parity is consistently associated with a decreased risk of breast cancer, but may adversely affect survival, especially if these births occurred close to being diagnosed. Specific Aims: The general focus of the study is to elucidate relationships and potential mechanistic pathways between breast cancer incidence and survival (both all-cause and disease free survival). The specific aims are to evaluate 1) whether specific reproductive risk factors are independent predictors of survival. The considered reproductive factors will include, but are not limited to, age at menarche, number of pregnancies, and the timing of pregnancies relative to the breast cancer diagnosis and 2) whether previous use of oral contraceptives (OCs) is predictive of survival. Study Design: We propose to address these questions in a cohort of young, mostly pre-menopausal women with invasive breast cancer residing in 5 counties of New Jersey (n= 447) and in the Atlanta, GA area (n=856) who were diagnosed between 1990 and 1992. These women were cases in a population-based case-control study, the Women’s Interview Study of Health (WISH) who were then followed up for approximately 8 years to determine various survival end points (all-cause mortality and recurrence). Detailed information on a wide variety of characteristics (e.g. medical history, reproductive history, diet, demographic factors) was collected during a structured in-person interview. Potential Outcomes and Benefits: There is a great need for elucidation of mechanisms that affect survival, especially those related to non-clinical factors. Specifically, this study will deepen our understanding of the relationship between breast cancer incidence and survival. This study population is unique in its inclusion of a large number of younger, pre-menopausal women who have not been systematically studied in the past. The burden of breast cancer in this group is considerable, despite the relative low incidence, because breast cancer in this group tends to be more aggressive and is associated with a worse prognosis. There is a also a tremendous need for women to know what they can do to affect the course of their disease, and given that OC use is modifiable, women could potentially alter contraceptive choices in order to improve prognosis.

    Lay Abstract:
    Title: Reproduction, oral contraceptives & breast cancer survival in young women LAY ABSTRACT While much is known about clinical predictors and how they influence survival in women with breast cancer, little is known about non-clinical predictors of survival, especially among younger women. It has been well characterized that characteristics of women’s reproductive lives (age at first period, age at menopause, number of children, and age at first pregnancy) influence whether women get breast cancer, but little research has examined whether these same factors, in addition to oral contraceptive (OC) use, influence how long women survive after they become diagnosed with breast cancer. It is thought reproductive factors may influence both risk and survival through an estrogen pathway. A few studies have found reproductive factors to be important in predicting survival, but have suffered from drawbacks, such as small numbers of women, especially at younger ages. Various characteristics of women’s reproductive lives may influence the course of breast cancer after it has been diagnosed, potentially in ways that differ from effects on risk of getting breast cancer. For example, giving birth to children (particularly at younger ages) is consistently associated with a decreased risk of breast cancer, but may adversely affect survival, especially if these births occurred soon (2-5 years) before becoming diagnosed. The general goal of the study is to examine whether factors that influence the development of breast cancer are also important for prognosis. Specifically, we propose to determine whether specific reproductive risk factors are predictors of survival, after taking into account known characteristics that influence survival. The reproductive factors that will be considered include, but are not limited to, age at first period, number of pregnancies, and the timing of pregnancies relative to the breast cancer diagnosis. Additionally, we will examine whether previous use of OCs is predictive of survival. These questions will be addressed using a previously assembled group of young, mostly pre-menopausal women with breast cancer residing in 5 counties of New Jersey (n= 447) and in the Atlanta, GA area (n=856) who were diagnosed between 1990 and 1992. These women were originally enrolled in a study of breast cancer risk factors among younger women entitled the Women’s Interview Study of Health (WISH) who were then followed up for approximately 8 years to investigate survival. Detailed information on a wide variety of characteristics (e.g. medical history, reproductive history, diet, demographic factors) was collected during a structured in-person interview. Specifically, this study will deepen our understanding of the relationship between factors determining risk of breast cancer and factors influencing survival. This study population is unique in its inclusion of a large number of younger, pre-menopausal women who have not been systematically studied in the past. Despite having a relatively low risk of breast cancer, the burden of breast cancer among younger women is considerable because breast cancer in this group tends to be more aggressive and is associated with a worse prognosis. There is a also a tremendous need for women to know what they can do to affect the course of their disease, and given that OC use is modifiable, women could potentially alter contraceptive choices in order to improve prognosis.