Evidence map›Paper›PMID 30534999›Full record

ArticleAnnals of internal medicine2019

Breast Cancer Risk After Recent Childbirth: A Pooled Analysis of 15 Prospective Studies.

Hazel B Nichols, Minouk J Schoemaker, Jianwen Cai, Jiawei Xu, Lauren B Wright, Mark N Brook, Michael E Jones, Hans-Olov Adami, Laura Baglietto, Kimberly A Bertrand and 33 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Annals of internal medicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 126 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
126citing papers in PubMed, 4 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

126 citing papers in PubMed, 4 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Observational
  6. Review
  7. Article
  8. Review
  9. Postpartum breast cancer: evidence for a distinct phenotype.Journal of the National Cancer Institute · 2026
    Article
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  13. Article
  14. Review
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66 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

43 authors.

Hazel B NicholsUniversity of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina (H.B.N., J.C., J.X.).
Minouk J SchoemakerThe Institute of Cancer Research, London, United Kingdom (M.J.S., L.B.W., M.N.B., M.E.J., A.J.S.).
Jianwen CaiUniversity of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina (H.B.N., J.C., J.X.).
Jiawei XuUniversity of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina (H.B.N., J.C., J.X.).
Lauren B WrightThe Institute of Cancer Research, London, United Kingdom (M.J.S., L.B.W., M.N.B., M.E.J., A.J.S.).
Mark N BrookThe Institute of Cancer Research, London, United Kingdom (M.J.S., L.B.W., M.N.B., M.E.J., A.J.S.).
Michael E JonesThe Institute of Cancer Research, London, United Kingdom (M.J.S., L.B.W., M.N.B., M.E.J., A.J.S.).
Hans-Olov AdamiKarolinska Institutet, Stockholm, Sweden (H.A.).
Laura BagliettoUniversity of Pisa, Pisa, Italy (L.B.).
Kimberly A BertrandSlone Epidemiology Center at Boston University, Boston, Massachusetts (K.A.B., J.R.P.).
William J BlotVanderbilt-Ingram Cancer Center and Vanderbilt University School of Medicine, Nashville, Tennessee (W.J.B., W.Z.).
Marie-Christine Boutron-RuaultInstitut National de la Santé et de la Recherche Médicale (INSERM) U1018 and Institut Gustave Roussy Centre for Research in Epidemiology and Population Health, Villejuif, France (M.B.).
Miren DorronsoroPublic Health Direction and Biodonostia Research Institute and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Basque Regional Health Department, San Sebastian, Spain (M.D.).
Laure DossusInternational Agency for Research on Cancer, Lyon, France (L.D.).
A Heather EliassenBrigham and Women's Hospital, Harvard Medical School, and Harvard T.H. Chan School of Public Health, Boston, Massachusetts (A.H.E., R.M.T.).
Graham G GilesCancer Council Victoria and University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia (G.G.G., R.L.M.).
Inger T GramUniversity of Tromsø, The Arctic University of Norway, Tromsø, Norway (I.T.G.).
Susan E HankinsonUniversity of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, Massachusetts (S.E.H.).
Judy Hoffman-BoltonJohns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (J.H.).
Rudolf KaaksGerman Cancer Research Center, Heidelberg, Germany (R.K.).
Timothy J KeyUniversity of Oxford, Oxford, United Kingdom (T.J.K.).
Cari M KitaharaNational Cancer Institute, National Institutes of Health, Bethesda, Maryland (C.M.K., M.L.).
Susanna C LarssonInstitute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (S.C.L., A.W.).
Martha LinetNational Cancer Institute, National Institutes of Health, Bethesda, Maryland (C.M.K., M.L.).
Melissa A MerrittSchool of Public Health, Imperial College London, London, United Kingdom (M.A.M., E.R.).
Roger L MilneCancer Council Victoria and University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia (G.G.G., R.L.M.).
Valeria PalaCancer Registry of Norway, Institute of Population-Based Cancer Research, and University of Oslo, Oslo, Norway, and University of Southern California, Los Angeles, California (V.P.).
Julie R PalmerSlone Epidemiology Center at Boston University, Boston, Massachusetts (K.A.B., J.R.P.).
Petra H PeetersUniversity Medical Center Utrecht, Utrecht, the Netherlands (P.H.P.).
Elio RiboliSchool of Public Health, Imperial College London, London, United Kingdom (M.A.M., E.R.).
Malin SundUmeå University, Umeå, Sweden (M.S.).
Rulla M TamimiBrigham and Women's Hospital, Harvard Medical School, and Harvard T.H. Chan School of Public Health, Boston, Massachusetts (A.H.E., R.M.T.).
Anne TjønnelandDanish Cancer Society Research Center, Copenhagen, Denmark (A.T.).
Antonia TrichopoulouHellenic Health Foundation, Athens, Greece (A.T.).
Giske UrsinNorwegian University of Science and Technology, Trondheim, Norway (G.U., L.V.).
Lars VattenNorwegian University of Science and Technology, Trondheim, Norway (G.U., L.V.).
Kala VisvanathanJohns Hopkins Bloomberg School of Public Health and Johns Hopkins School of Medicine, Baltimore, Maryland (K.V.).
Elisabete WeiderpassKarolinska Institutet, Stockholm, Sweden, University of Tromsø, The Arctic University of Norway, Tromsø, Norway, and Folkhälsan Research Center, Helsinki, Finland (E.W.).
Alicja WolkInstitute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (S.C.L., A.W.).
Wei ZhengVanderbilt-Ingram Cancer Center and Vanderbilt University School of Medicine, Nashville, Tennessee (W.J.B., W.Z.).
Clarice R WeinbergNational Institute of Environmental Health Sciences, National Institutes of Health, Durham, North Carolina (C.R.W., D.P.S.).
Anthony J SwerdlowThe Institute of Cancer Research, London, United Kingdom (M.J.S., L.B.W., M.N.B., M.E.J., A.J.S.).
Dale P SandlerNational Institute of Environmental Health Sciences, National Institutes of Health, Durham, North Carolina (C.R.W., D.P.S.).

Funding

Virology Research Program (Program 4)P30CA016086 · NCI · UNIV OF NORTH CAROLINA CHAPEL HILL · PI Deborah F. Tate · 1985 to 2026
$201.5M
Southern Community Cohort StudyR01CA092447 · NCI · VANDERBILT UNIVERSITY MEDICAL CENTER · PI BLOT, WILLIAM J., ZHENG, WEI · 2001 to 2015
$74.0M
UNC-CH CENTER FOR ENVIRONMENTAL HEALTH &SUSCEPTIBILITYP30ES010126 · NIEHS · UNIV OF NORTH CAROLINA CHAPEL HILL · PI Melissa A. Troester · 2001 to 2026
$36.3M
Studies of Populations Exposed to Occupational Sources of RadiationZIACP010133 · NCI · DIVISION OF CANCER EPIDEMIOLOGY AND GENETICS · PI KITAHARA, CARI · 2009 to 2025
$34.2M
Tissue and Pathology CoreP50CA168504 · NCI · DANA-FARBER CANCER INST · PI MYLES A BROWN · 2013 to 2026
$30.1M
A Follow-up Study for Causes of Cancer in Black WomenU01CA164974 · NCI · BOSTON UNIVERSITY MEDICAL CAMPUS · PI Kimberly A. Bertrand, Yvette C Cozier · 2017 to 2026
$24.0M
Environmental and Genetic Risk Factors For Breast Cancer: The Sister StudyZIAES044005 · NIEHS · NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES · PI SANDLER, DALE P · 2009 to 2025
$22.7M
Long Term Multidisciplinary Study of Cancer in Women: The Nurses Health StudyUM1CA186107 · NCI · BRIGHAM AND WOMEN'S HOSPITAL · PI ELIASSEN, A. HEATHER, STAMPFER, MEIR · 2014 to 2023
$22.3M
FOLLOW-UP STUDY FOR CAUSES OF ILLNESS IN BLACK WOMENR01CA058420 · NCI · BOSTON UNIVERSITY MEDICAL CAMPUS · PI ROSENBERG, LYNN · 1999 to 2013
$20.7M
Life Course Cancer Epidemiology Cohort in WomenUM1CA176726 · NCI · HARVARD SCHOOL OF PUBLIC HEALTH · PI WILLETT, WALTER C. · 2013 to 2017
$15.7M
A Follow-up Study for Causes of Cancer in Black WomenUM1CA164974 · NCI · BOSTON UNIVERSITY MEDICAL CAMPUS · PI ROSENBERG, LYNN · 2012 to 2017
$13.7M
The Two Sister StudyZIAES102245 · NIEHS · NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES · PI WEINBERG, CLARICE · 2009 to 2025
$8.6M
Cancer Research UK 14136Cancer Research UK 16491Intramural NIH HHS Z01 ES044005Medical Research Council G0401527Medical Research Council G1000143Medical Research Council MR/M012190/1Medical Research Council MR/N003284/1NCATS NIH HHS KL2 TR001109NCI NIH HHS P30 CA016086NCI NIH HHS P50 CA168504NCI NIH HHS R01 CA058420NCI NIH HHS R01 CA092447NCI NIH HHS U01 CA164974NCI NIH HHS UM1 CA164974NCI NIH HHS UM1 CA176726NCI NIH HHS UM1 CA186107NIEHS NIH HHS P30 ES010126World Health Organization 001
6 · The paper itself

Abstract

Background: Parity is widely recognized as protective for breast cancer, but breast cancer risk may be increased shortly after childbirth. Whether this risk varies with breastfeeding, family history of breast cancer, or specific tumor subtype has rarely been evaluated. Objective: To characterize breast cancer risk in relation to recent childbirth. Design: Pooled analysis of individual-level data from 15 prospective cohort studies. Setting: The international Premenopausal Breast Cancer Collaborative Group. Participants: Women younger than 55 years. Measurements: During 9.6 million person-years of follow-up, 18 826 incident cases of breast cancer were diagnosed. Hazard ratios (HRs) and 95% CIs for breast cancer were calculated using Cox proportional hazards regression. Results: Compared with nulliparous women, parous women had an HR for breast cancer that peaked about 5 years after birth (HR, 1.80 [95% CI, 1.63 to 1.99]) before decreasing to 0.77 (CI, 0.67 to 0.88) after 34 years. The association crossed over from positive to negative about 24 years after birth. The overall pattern was driven by estrogen receptor (ER)-positive breast cancer; no crossover was seen for ER-negative cancer. Increases in breast cancer risk after childbirth were pronounced when combined with a family history of breast cancer and were greater for women who were older at first birth or who had more births. Breastfeeding did not modify overall risk patterns. Limitations: Breast cancer diagnoses during pregnancy were not uniformly distinguishable from early postpartum diagnoses. Data on human epidermal growth factor receptor 2 (HER2) oncogene overexpression were limited. Conclusion: Compared with nulliparous women, parous women have an increased risk for breast cancer for more than 20 years after childbirth. Health care providers should consider recent childbirth a risk factor for breast cancer in young women. Primary Funding Source: The Avon Foundation, the National Institute of Environmental Health Sciences, Breast Cancer Now and the UK National Health Service, and the Institute of Cancer Research.

Indexed as

ParturitionAdolescentAdultBreast FeedingBreast NeoplasmsFemaleGenetic Predisposition to DiseaseHumansMaternal AgeMiddle AgedParityPregnancyPremenopauseProportional Hazards ModelsProspective StudiesReceptors, EstrogenReceptors, Estrogen

Identifiers

PMID30534999
PMCPMC6760671

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.