Breast cancer incidence before age 55 in relation to parity and age at first and last births: a prospective study of one million Norwegian women

Abstract

We examined the relation between breast cancer, parity, and age at first and last births in a large national cohort of young women in Norway. We estimated relative incidence rates by Poisson regression analyses of person-years at risk with parity and age at last (most recent) birth as time-dependent variables. A total of 1,071,795 women were included in follow-up, contributing a total of 16,643,883 person-years in the age range 20-54 years. Follow-up times ranged from 1 month to 34.5 years. A total of 4,302 women were diagnosed with breast cancer during follow-up. With adjustment for age at first and last births, high parity was associated with an overall reduced risk of breast cancer (incidence rate ratio = 0.46; 95% confidence interval = 0.36-0.59 for women with five or more children vs uniparous women). Among women age 20-29 years, however, the results suggested an increase in risk with increasing parity (incidence rate ratio = 1.25; 95% confidence interval = 0.64-2.45 for women with three children vs uniparous women). The protective effect of high parity was particularly strong among women with first birth before the age of 20 years and rather weak among those with first birth at age 30 years or more. Low ages at first and last births were both associated with reduced breast cancer risk in analyses with adjustment for the other factor, with the association with age at last birth being slightly stronger.