Reproductive factors and breast cancer risk according to joint estrogen and progesterone receptor status: a meta-analysis of epidemiological studies

Introduction Although reproductive factors have been known for decades to be associated with breast cancer risk, it is unclear to what extent these associations differ by estrogen and progesterone receptor (ER/PR) status. This report presents the first meta-analysis of results from epidemiological studies that have investigated parity, age at first birth, breastfeeding, and age at menarche in relation to ER+PR+ and ER-PR- cancer risk. Materials and methods We calculated summary relative risks (RRs) and corresponding 95% confidence intervals (CIs) using a fixed effects model. Results Each birth reduced the risk of ER+PR+ cancer by 11% (RR per birth = 0.89, 95% CI = 0.84 - 0.94), and women who were in the highest age at first birth category had, on average, 27% higher risk of ER+PR+ cancer compared with women who were in the youngest age at first birth category (RR = 1.27, 95% CI = 1.07 - 1.50). Neither parity nor age at first birth was associated with the risk of ER-PR- cancer ( RR per birth = 0.99, 95% CI = 0.94 - 1.05; RR of oldest versus youngest age at first birth category = 1.01, 95% CI = 0.85 - 1.20). Breastfeeding and late age at menarche decreased the risk of both receptor subtypes of breast cancer. The protective effect of late age at menarche was statistically significantly greater for ER+PR+ than ER-PR- cancer ( RR = 0.72 for ER+PR+ cancer; RR = 0.84 for ER-PR- cancer, p for homogeneity = 0.006). Conclusion Our findings suggest that breastfeeding ( and age at menarche) may act through different hormonal mechanisms than do parity and age at first birth.