Breast cancer risk in relation to history of preeclampsia and hyperemesis gravidarum: Prospective analysis in the Generations Study

TY - JOUR

T1 - Breast cancer risk in relation to history of preeclampsia and hyperemesis gravidarum

T2 - Prospective analysis in the Generations Study

AU - Wright, Lauren B

AU - Schoemaker, Minouk J

AU - Jones, Michael E

AU - Ashworth, Alan

AU - Swerdlow, Anthony J

N1 - © 2018 The Authors International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.

PY - 2018/8/15

Y1 - 2018/8/15

N2 - Preeclampsia and hyperemesis gravidarum are pregnancy complications associated with altered sex hormone levels. Previous studies suggest preeclampsia may be associated with a decreased risk of subsequent breast cancer and hyperemesis with an increased risk, but the evidence remains unclear. We used data from the Generations Study, a large prospective study of women in the United Kingdom, to estimate relative risks of breast cancer in relation to a history of preeclampsia and hyperemesis using Cox regression adjusting for known breast cancer risk factors. During 7.5 years average follow-up of 82,053 parous women, 1,969 were diagnosed with invasive or in situ breast cancer. Women who had experienced preeclampsia during pregnancy had a significantly decreased risk of premenopausal breast cancer (hazard ratio (HR) =0.67, 95% confidence interval (CI): 0.49-0.90) and of HER2-enriched tumours (HR = 0.33, 95% CI: 0.12-0.91), but there was no association with overall (HR = 0.90, 95% CI: 0.80-1.02) or postmenopausal (HR = 0.97, 95% CI: 0.85-1.12) breast cancer risk. Risk reductions among premenopausal women were strongest within 20 years since the last pregnancy with preeclampsia. Hyperemesis was associated with a significantly increased risk of HER2-enriched tumours (HR = 1.76, 95% CI: 1.07-2.87), but not with other intrinsic subtypes or breast cancer risk overall. These results provide evidence that preeclampsia is associated with a decreased risk of premenopausal and HER2-enriched breast cancer and that hyperemesis, although not associated with breast cancer risk overall, may be associated with raised risk of HER2-enriched tumours.

AB - Preeclampsia and hyperemesis gravidarum are pregnancy complications associated with altered sex hormone levels. Previous studies suggest preeclampsia may be associated with a decreased risk of subsequent breast cancer and hyperemesis with an increased risk, but the evidence remains unclear. We used data from the Generations Study, a large prospective study of women in the United Kingdom, to estimate relative risks of breast cancer in relation to a history of preeclampsia and hyperemesis using Cox regression adjusting for known breast cancer risk factors. During 7.5 years average follow-up of 82,053 parous women, 1,969 were diagnosed with invasive or in situ breast cancer. Women who had experienced preeclampsia during pregnancy had a significantly decreased risk of premenopausal breast cancer (hazard ratio (HR) =0.67, 95% confidence interval (CI): 0.49-0.90) and of HER2-enriched tumours (HR = 0.33, 95% CI: 0.12-0.91), but there was no association with overall (HR = 0.90, 95% CI: 0.80-1.02) or postmenopausal (HR = 0.97, 95% CI: 0.85-1.12) breast cancer risk. Risk reductions among premenopausal women were strongest within 20 years since the last pregnancy with preeclampsia. Hyperemesis was associated with a significantly increased risk of HER2-enriched tumours (HR = 1.76, 95% CI: 1.07-2.87), but not with other intrinsic subtypes or breast cancer risk overall. These results provide evidence that preeclampsia is associated with a decreased risk of premenopausal and HER2-enriched breast cancer and that hyperemesis, although not associated with breast cancer risk overall, may be associated with raised risk of HER2-enriched tumours.

KW - Adult

KW - Breast Carcinoma In Situ/epidemiology

KW - Breast Neoplasms/complications

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Hyperemesis Gravidarum/complications

KW - Middle Aged

KW - Neoplasm Invasiveness

KW - Postmenopause

KW - Pre-Eclampsia/epidemiology

KW - Pregnancy

KW - Premenopause

KW - Proportional Hazards Models

KW - Prospective Studies

KW - Receptor, ErbB-2/metabolism

KW - Risk Factors

KW - United Kingdom/epidemiology

U2 - 10.1002/ijc.31364

DO - 10.1002/ijc.31364

M3 - Article

C2 - 29516507

SN - 0020-7136

VL - 143

SP - 782

EP - 792

JO - International Journal of Cancer

JF - International Journal of Cancer

IS - 4

ER -