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• W2023654845 abstract "In referring to “the worldwide epidemiological data on breast cancer and breastfeeding”, the Collaborative Group on Hormonal Factors in Breast Cancer (July 20, p 187)1Collaborative Group on Hormonal Factors in Breast CancerBreast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50 302 women with breast cancer and 96 973 women without the disease.Lancet. 2002; 360: 187-195Summary Full Text Full Text PDF PubMed Scopus (1040) Google Scholar list “the ten studies that are not included” in the combined analysis. We were surprised to notice that the first report from a cohort study, published by our group 14 years ago,2Kv{å}le G Heuch I Lactation and cancer risk: is there a relation specific to breast cancer?.J Epidemiol Community Health. 1988; 42: 30-37Crossref PubMed Scopus (66) Google Scholar was not referred to. Our cohort included women in three counties in Norway, born in 1886–1928 and living mostly in rural areas, largely reflecting breastfeeding habits different from those seen later. The mean total period of breastfeeding in parous women was 16·6 months (SD 16·0 months). Our original follow-up included diagnoses recorded at the Cancer Registry of Norway in 1961–80. We have now done statistical analyses covering the complete period 1961–98. Among 46 503 parous women with information on breastfeeding and age at first birth, 2184 cases of breast cancer occurred. Since associations between breast cancer and breastfeeding can depend on age at diagnosis,3Lipworth L Bailey LR Trichopoulos D History of breast-feeding in relation to breast cancer risk: a review of the epidemiologic literature.J Natl Cancer Inst. 2000; 92: 302-312Crossref PubMed Scopus (166) Google Scholar our analysis was subdivided according to attained age. Relative risk estimates in the middle age interval 50–69 years (989 cases; table) showed a moderate inverse relation. For women younger than 50 years (199 cases), the relative risk estimate per 12 months of breastfeeding was 1·06 (95% CI 0·85–1·31) and for women 70 years of age or older (996 cases), the estimate was 1·04 (0·97–1·12).TableRelative risk of breast cancer according to total duration of breastfeeding among parous women aged 50–69 yearsNumber of casesRelative risk (95% CI)*Based on Poisson regression analysis, adjusted for age (5-year groups), birth cohort (5-year groups), urban/ rural residence, parity (1, 2, …6, 7+), and age at first birth (≤19, 20–24, 25–29, 30–34, ≥35 years).Months of breastfeeding (median)Never (0)981 (reference)≤6 (3)2730·99 (0·79–1·25)7–18 (12)3910·95 (0·76–1·20)19–30 (24)1510·94 (0·71–1·23)31–54 (37)690·89 (0·62–1·28)≥55 (70)70·50 (0·21–1·23)Relative risk per 12 months..0·95 (0·87–1·03)* Based on Poisson regression analysis, adjusted for age (5-year groups), birth cohort (5-year groups), urban/ rural residence, parity (1, 2, …6, 7+), and age at first birth (≤19, 20–24, 25–29, 30–34, ≥35 years). Open table in a new tab Our estimate represents a reduction in relative risk of 5·4% for every 12 months of breastfeeding in the past among women aged 50–69 years, which is consistent with the overall 4·3% reduction seen in the collaborative study.1Collaborative Group on Hormonal Factors in Breast CancerBreast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50 302 women with breast cancer and 96 973 women without the disease.Lancet. 2002; 360: 187-195Summary Full Text Full Text PDF PubMed Scopus (1040) Google Scholar For women younger than 50 years, our risk estimate did not represent an inverse relation, but confidence limits were wide. By contrast, the confidence limits for women 70 years of age or older could be compatible with a protective effect of breastfeeding, which has mostly disappeared some time after the lactation period.4Tryggvadottir L Tulinius H Eyfjord JE Sigurvinsson T Breastfeeding and reduced risk of breast cancer in an Icelandic cohort study.Am J Epidemiol. 2001; 154: 37-42Crossref PubMed Scopus (65) Google Scholar Another possibility is that prolonged breast-feeding simply delays the occurrence of breast cancer in younger women.3Lipworth L Bailey LR Trichopoulos D History of breast-feeding in relation to breast cancer risk: a review of the epidemiologic literature.J Natl Cancer Inst. 2000; 92: 302-312Crossref PubMed Scopus (166) Google Scholar Few age-specific results were given in the collaborative study,1Collaborative Group on Hormonal Factors in Breast CancerBreast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50 302 women with breast cancer and 96 973 women without the disease.Lancet. 2002; 360: 187-195Summary Full Text Full Text PDF PubMed Scopus (1040) Google Scholar although relative risk estimates were similar for women younger than 50 years and 50 years or older. With a mean age at diagnosis of 50·1 years, the age distribution cannot be fully representative of an ordinary population of breast cancer patients. Whether the data indicate an attenuation of the protective effect of breastfeeding in older women would still be interesting to know. This information could have major implications for the estimated reduction in cumulative breast cancer incidence,1Collaborative Group on Hormonal Factors in Breast CancerBreast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50 302 women with breast cancer and 96 973 women without the disease.Lancet. 2002; 360: 187-195Summary Full Text Full Text PDF PubMed Scopus (1040) Google Scholar which might be achieved by adopting other breastfeeding patterns in developed countries. Breast cancer and breastfeedingAuthors' reply Full-Text PDF" @default.
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