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Breast cancer risk among women with long-standing lactation and reproductive parameters at low risk level: a case–control study in Northern Tanzania

  • Epidemiology
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Abstract

Breast cancer is the leading cause of death among women worldwide. Studies in industrialised countries identified age at menarche, age at first full-term pregnancy, and lactation as determining factors in the aetiology of breast cancer. 115 female breast cancer patients (cases) and 230 age- and district-matched women clinically free from breast cancer (controls) were interviewed about their reproductive history and socioeconomic condition. Semi-structured interviews including anthropometric measurements were conducted by trained enumerators. The median age was 50 years (min/max 26 to 85 years). Estimated median BMI at age 20 was 21 kg/m2 in both cases and controls. Median lifelong lactation of the mothers was 96 months (cases) and 108 months (controls). A high BMI at 20 years was associated with an increased breast cancer risk (OR 1.31 95% CI 1.11–1.55, P < 0.01). The odds ratio for lifelong lactation was slightly below one (OR 0.99 95% CI 0.98–1.00, P < 0.01). There was no significant association in risk for BMI at interview (median 25 kg/m2 of cases and 26 kg/m2 of controls), age at menarche (median 16 years), and age at first full-term pregnancy (median 20 years). The association of increased risk with higher BMI at age 20 years remained significant after stratification for menopause (premenopausal: OR 1.41 95% CI 1.10–1.81, P = 0.01; postmenopausal: OR 1.38 95% CI 1.06–1.80, P = 0.02). Late age at menarche and prolonged lifelong lactation were associated with a risk reduction among premenopausal women (ORmenarche 0.74 95% CI 0.56–1.00, P = 0.05; ORlactation 0.98 95% CI 0.97–0.99, P < 0.01). In conclusion, long-standing lactation and reproductive behaviour are associated with a lower breast cancer risk in the region. As current changes in lifestyle affect age at menarche, reproductive behaviour, and nutritional status, an increased incidence of breast cancer is to be expected. Preventive efforts should include advice on reproductive and breastfeeding behaviour.

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Acknowledgments

We thank the women of the Kilimanjaro Region and the members of the research team. Greatly appreciated is the input of: Mark Swai for his contribution to the study design and implementation, Joel Julia Mfinanga for conducting the interviews and physical examinations, Marion Mann†, Heiner Boeing, and Gerrit Eichner for statistical guidance and data analysis. The contributions of the authors were as follows: Irmgard Jordan analysed and interpreted the data and drafted the manuscript; Antje Hebestreit and Michael Krawinkel were principal investigators and contributed to the manuscript; Britta Swai conducted the study implementation and data entry in Tanzania. The study was funded by Henskes Ltd., Laatzen, Germany, Plural, Sachse and Heinzelmann Ltd., Germany, as well as the German Academic Exchange Service (DAAD).

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Authors and Affiliations

  1. Institute of Nutritional Sciences, Justus-Liebig-University Giessen, Giessen, Germany

    Irmgard Jordan & Michael B. Krawinkel

  2. Bremen Institute for Prevention Research and Social Medicine, Bremen, Germany

    Antje Hebestreit

  3. Kilimanjaro Christian Medical Center, Moshi, Tanzania

    Britta Swai

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  1. Irmgard Jordan
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  2. Antje Hebestreit
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  3. Britta Swai
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  4. Michael B. Krawinkel
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Correspondence to Michael B. Krawinkel.

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Jordan, I., Hebestreit, A., Swai, B. et al. Breast cancer risk among women with long-standing lactation and reproductive parameters at low risk level: a case–control study in Northern Tanzania. Breast Cancer Res Treat 142, 133–141 (2013). https://doi.org/10.1007/s10549-010-1255-7

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  • DOI: https://doi.org/10.1007/s10549-010-1255-7

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