Abstract
BackgroundBlack-white disparities in breast cancer incidence rates and birth outcomes raise concerns about potential disparities in the reproductive health of premenopausal breast cancer survivors. We examined the prevalence of preterm birth (PTB), low birthweight (LBW), and small for gestational age (SGA) by breast cancer history and effect modification by race.MethodsWe analyzed linked North Carolina birth records and Central Cancer Registry files from 1990 to 2009 (n = 2,325,229). We used multivariable negative log-binomial regression to calculate prevalence ratios (PRs) and 95% confidence intervals (CIs) for the association between breast cancer history and PTB, LBW, and SGA.ResultsOf 1,912,269 eligible births, 512 births were to mothers with a previous breast cancer diagnosis history. Average age at breast cancer diagnosis was 31.8 years (SD = 4.7). Mean time from diagnosis to delivery was 3.3 years (SD = 2.8). After multivariable adjustment, the PR was 1.67 (95% CI, 1.42–1.97) for PTB, 1.50 (95% CI, 1.23–1.84) for LBW, and 1.30 (95% CI, 1.05–1.61) for SGA comparing women with a breast cancer history to the general population. Among black mothers, the PRs associated with breast cancer history for PTB, LBW, and SGA were 1.31 (95% CI, 1.00–1.72), 1.49 (95% CI, 1.14–1.94), and 1.44 (95% CI, 1.11–1.87), respectively. The corresponding PRs among white mothers were 2.06 (95% CI, 1.67–2.54), 1.53 (95% CI, 1.12–2.08), and 1.10 (95% CI, 0.77–1.58), respectively. The interaction between breast cancer history and race was statistically significant for associations with PTB, but not for LBW or SGA.ConclusionsIn our data, women with a breast cancer history were at higher risk of delivering a PTB, LBW, or SGA infant, especially if they received chemotherapy or gave birth within 2 years of their breast cancer diagnosis date.
Highlights
Black-white disparities in breast cancer incidence rates and birth outcomes raise concerns about potential disparities in the reproductive health of premenopausal breast cancer survivors
Our study examined the prevalence of preterm birth (PTB), low birthweight (LBW), and small for gestational age (SGA) according to breast cancer history prior to infant delivery in a population-based study in North Carolina (NC), and evaluated potential effect modification by race
The interaction between breast cancer history and race was statistically significant for associations with PTB (P interaction = 0.01), but not for LBW (P interaction = 0.9) or SGA (P interaction = 0.2)
Summary
Black-white disparities in breast cancer incidence rates and birth outcomes raise concerns about potential disparities in the reproductive health of premenopausal breast cancer survivors. We examined the prevalence of preterm birth (PTB), low birthweight (LBW), and small for gestational age (SGA) by breast cancer history and effect modification by race. With an increasing number of women delaying childbearing [1, 2] and improved breast cancer survival among women diagnosed before the age of 50 years [3], many young breast cancer patients face decisions at the time of diagnosis that may influence their future reproductive health. Black women are more likely than their white counterparts to be diagnosed with breast cancer during their reproductive years [9] and deliver PTB, LBW, or SGA infants. Black women are 41% more likely to deliver a PTB infant, 63% more likely to deliver a LBW infant [2], and two to three times more likely to deliver a SGA infant [14, 15]
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