© 2000 by Oxford University Press
Journal of the National Cancer Institute, Vol. 92, No. 4, 302-312,
February 16, 2000
© 2000 Oxford University Press
REVIEW |
History of Breast-Feeding in Relation to Breast Cancer Risk: a Review of the Epidemiologic Literature
Affiliations of authors: L. Lipworth, International Epidemiology Institute, Rockville, MD, and Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN; L. R. Bailey, Program in Human Genetics, Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine; D. Trichopoulos, Department of Epidemiology, Harvard School of Public Health, Boston, MA
Correspondence to: Loren Lipworth, Sc.D., International Epidemiology Institute, 1455 Research Blvd., Suite 550, Rockville, MD 20850 (e-mail: loren3{at}earthlink.net).
The purpose of this review is to critically evaluate the collective epidemiologic evidence that a history of breast-feeding may decrease the risk of breast cancer. Original data for inclusion were identified through a MEDLINE® search of the English language literature from 1966 through 1998. To date, virtually all epidemiologic data regarding breast-feeding and breast cancer risk are derived from case-control studies, which vary according to classification of breast-feeding history. Overall, the evidence with respect to "ever" breast-feeding remains inconclusive, with results indicating either no association or a rather weak protective effect against breast cancer. An inverse association between increasing cumulative duration of breast-feeding and breast cancer risk among parous women has been reported in some, but not all, studies; the failure to detect an association in some Western populations may be due to the low prevalence of prolonged breast-feeding. It appears that the protective effect, if any, of long-term breast-feeding is stronger among, or confined to, premenopausal women. It has been hypothesized that an apparently protective effect of breast-feeding may be due to elevated breast cancer risk among women who discontinue breast-feeding or who take medication to suppress lactation; however, the evidence is limited and should be interpreted with caution. The biology underlying a protective effect of breast-feeding and why this should be restricted to premenopausal women remain unknown, although several mechanisms have been postulated (hormonal changes, such as reduced estrogen; removal of estrogens through breast fluid; excretion of carcinogens from breast tissue through breast-feeding; physical changes in the mammary epithelial cells, reflecting maximal differentiation; and delay of the re-establishment of ovulation). While breast-feeding is a potentially modifiable behavior, the practical implication of reduced breast cancer risk among premenopausal women with prolonged durations of breast-feeding may be of marginal importance, particularly in Western societies.
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