Placental characteristics and reduced risk of maternal breast cancer
Placental characteristics and reduced risk of maternal breast cancer
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DOI：
10.1093/jnci/93.15.1133
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发表时间：
2001-08-01
期刊：
影响因子：
--
通讯作者：
Siiteri, PK
中科院分区：
文献类型：
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作者：
Cohn, BA;Cirillo, PM;Siiteri, PK
背景：怀孕期间患有先兆子痫的女性随后患乳腺癌的风险较低。我们检查了胎盘尺寸或功能减小的其他标志物（包括怀孕期间血压升高）是否可以预测孕产妇乳腺癌的减少。方法：儿童健康与发展研究是对 1959 年至 1967 年间参加凯撒永久健康计划的孕妇进行的 40 年随访。我们确定了 3804 名白人妇女，她们的胎盘检查和其他研究变量数据是可用的。截至 1997 年，已有 146 名女性罹患浸润性乳腺癌。比例风险模型用于估计乳腺癌与胎盘功能标志物的关联。所有统计检验都是双向的。 结果：妊娠中期和晚期之间的血压升高与乳腺癌发病率呈线性关系，最高四分位数显示降低了 51%（95% 置信区间 [CI] = 20% 至 70%），这不能用先兆子痫来解释。较小的胎盘直径与乳腺癌发病率降低独立相关。这种关联随着首次怀孕时的年龄而增加 (P= .008)。母体胎盘梗死与乳腺癌发病率降低 60% 相关（95% CI = 12% 至 82%）。综合起来，胎盘危险因素与乳腺癌发病率降低高达 94% 相关（95% CI = 80% 至 98%）。结论：胎盘较小、母体胎盘底梗塞和妊娠期间血压升高与母体乳腺癌发病率降低相关。在胎盘直径较小的情况下，第一次怀孕时观察到的胎盘直径随着年龄的增长而减小得较大，这表明存在一个阻止现有病变发展的过程。阐明这些关联的机制可以为乳腺癌的预防和治疗提供线索。
Background:Women who have preeclampsia during pregnancy are at reduced risk of subsequent breast cancer. We examined whether other markers of reduced placental size or function, including increased blood pressure during pregnancy, predict a reduction in maternal breast cancer.Methods:The Child Health and Development Studies is a 40-year follow-up of pregnant women enrolled in the Kaiser Permanente health plan between 1959 and 1967. We identified 3804 white women for whom data were available on placental examinations and other study variables. As of 1997, 146 women had developed invasive breast cancer. Proportional hazards models were used to estimate associations of breast cancer with markers of placental function. All statistical tests were two-sided.Results:A blood pressure increase between the second and third trimesters exhibited a linear relationship with breast cancer rate, with the highest quartile showing a 51% reduction (95% confidence interval [CI] = 20% to 70%) that was not explained by preeclampsia. Smaller placental diameter was independently associated with a reduced breast cancer rate; the association increased with age at first pregnancy (P= .008). Maternal floor infarction of the placenta was associated with a 60% reduction in breast cancer rate (95% CI = 12% to 82%). In combination, placental risk factors were associated with a reduction in the breast cancer rate of as high as 94% (95% CI = 80% to 98%).Conclusions:Smaller placentas, maternal floor infarction of the placenta, and increasing blood pressure during pregnancy were associated with reduced maternal breast cancer. In the case of smaller placental diameter, the larger reduction observed with older age at first pregnancy suggests a process in which promotion of an existing lesion is blocked. Elucidating the mechanisms for these associations could provide clues to breast cancer prevention and treatment.