Reproductive factors and specific histological types of breast cancer: prospective study and meta-analysis

Little is known about how reproductive factors affect the risk of breast cancers of different histology. In an analysis of prospective data on 1.2 million middle-aged UK women, we used proportional hazards models to estimate the relative risks of six histological types in relation to menarche, childbearing and menopause. During 8.7 million person-years of follow-up, 17 923 ductal, 3332 lobular, 1062 tubular, 944 mixed ductal lobular, 330 mucinous and 117 medullary cancers were diagnosed. The effect of both age at menarche and age at first birth was greatest for lobular tumours; relative risks per 5-year increase in age at menarche for ductal, lobular, and tubular cancers were 0.93 ( 0.87-0.99), 0.65 ( 0.56-0.76), and 0.75 ( 0.57-0.98), respectively ( P-value for heterogeneity =0.0001); and the relative risks per 5-year increase in age at first birth were 1.10 ( 1.07-1.12), 1.23 ( 1.17-1.29), and 1.13 ( 1.03-1.23), respectively ( P-value for heterogeneity =0.0006). Increasing parity reduced the risk of each tumour type, except medullary cancers, but the reduction in risk was greater for mucinous cancers than for any other subtype considered (P < 0.05 for comparison with each other subtype in turn). The effect of menopause did not vary significantly by tumour histology. Meta-analysis of published results on the effects of age at menarche and age at first birth on ductal and lobular cancers were in keeping with our findings.