[The significance of reproductive history for prognosis of primary breast cancer]. / Fødselsmønsterets betydning for prognosen ved primaer mammacancer.

The aetiological impact of a woman's reproductive history on breast cancer is well established, whereas the prognostic influence of the reproductive pattern is less well described. A literature search with focus on three Danish studies is described. Status as parous/nulliparous and number of births appear to have no prognostic influence. Women who have their first child at an early age have a lower survival than women who have postponed their first childbirth. This may eventually be explained by selection, i.e. that women with an early first full-term pregnancy represent a group with a more malignant disease. Women diagnosed in the first two years after childbirth have a significantly lower survival, probably because the cancer, being subclinical during pregnancy, is affected by the high oestrogen concentrations with aggressive growth as the outcome. Pregnancy after treatment of breast cancer does not appear to have a negative influence on the prognosis.

[Should all younger patients with breast cancer be offered adjuvant cytotoxic chemotherapy?]. / Bør alle yngre mammacancerpatienter tilbydes adjuverende cytotoksisk kemoterapi?

The aim of the study was to investigate whether young age at diagnosis is a negative prognostic factor in primary breast cancer and how stage of disease at diagnosis and treatment may influence such an association. It was conducted as a retrospective cohort study based on a population-based data-base of breast cancer diagnosis with detailed information on tumour characteristics, treatment regimens, and vital status and included 10,356 patients with primary breast cancer less than 50 years of age at diagnosis. The main outcome measures were relative risk of dying within the first ten years after diagnosis according to age at diagnosis, adjusted for effect of known prognostic factors and expected mortality. Overall, young patients with low risk disease who did not receive adjuvant treatment had a significantly increasing risk of dying with decreasing age at diagnosis (adjusted relative risk: 45-49 years: 1 (reference); 40-44 years: 1.12 (0.89-1.40); 35-39 years: 1.40 (1.10-1.78); < 35 years: 2.18 (1.64-2.89). However, a similar trend was not seen in young patients who received adjuvant cytotoxic therapy. We found the same difference as above when comparing women receiving no treatment with those receiving adjuvant cytotoxic therapy within strata of node negative patients and patients with the same tumour size. In conclusion, the negative prognostic effect of young age is almost exclusively seen in women diagnosed with low risk disease not receiving adjuvant cytotoxic therapy, whereas young women who receive adjuvant cytotoxic therapy have the same prognosis as middle-aged women. These results suggest that young women with breast cancer, on the basis of age alone, should be regarded as high risk patients and be given adjuvant cytotoxic therapy.

[Menstrual cycle and surgery of breast cancer. Point of time for the surgery of primary breast cancer in connection with menstrual cycle is without prognostic significance]. / Menstruationscyklus og operation for mammacancer. Tidspunktet for operation for primoer mammacancer i forhold til menstruationscyklus er uden prognostisk betydning.

From 1977 to 1989 6488 patients under fifty years with primary breast cancer were registered in the nationwide Danish Breast Cancer Cooperative Group (DBCG). Among these information on last menstrual period prior to surgery was available in 1635 cases which constitute the study group of the present analysis. The group was representative of the total group with regard to prognostic factors and survival. In the study group time of surgery in relation to last menstrual period was found to have no influence on five- and ten year survival.