ANNOTATED BIBLIOGRAPHY

Maternal Breast Cancer Risk After the Death of a Child Lambe M, Cerrato R, Askling J, et al

Int J Cancer 110:763-766, 2004

The possibility that stressful life events can increase women’s riskof developing breast cancer, although widely accepted among thelay public, has been viewed with skepticism in the scientific litera-ture. Reviews of the limited body of previous research on this topichave emphasized the small sample sizes in most studies, obviousmethodologic weaknesses (e.g., cross-sectional designs), and in-consistent results.1,2 In contrast, Lambe and colleagues have takenadvantage of the remarkable research resource provided by nation-wide registry databases in Sweden to conduct a large-scale case-control study of more than 169,000 women with objective andprospective data on a major life stressor—the death of a child.Although the overall risk estimate for breast cancer (odds ratio[OR] = 1.05; 95% confidence interval [CI] 0.96-1.15) was not sig-nificant after controlling for age, parity, age at first birth, and edu-cation, the risk was significantly elevated (OR = 2.65; 95% CI 1.06-6.60) for women who had lost their only child when that child was1-4 years old. These findings complement recent results from an-other well-controlled, large-scale study from Scandinavia byLillberg and colleagues.3 In that cohort study, in which Finnishdatabases were used, data from self-report questionnaires about ma-jor stressful life events collected in 1981 were significantly associ-ated with the women’s risk of developing breast cancer between1982 and 1996 (hazard ratio = 1.35; 95% CI, 1.09-1.67). Together,these findings suggest that it would be premature to rule out lifestress as a risk factor for breast cancer and indicate the need for ad-ditional carefully crafted research.

D. H. Bovbjerg, PhD

References

1. Petticrew M, Fraser JM, Regan MF: Adverse life-events andrisk of breast cancer: A meta-analysis. Brit J Health Psych 4:1-17, 1999.

2. Garssen B: Psychological factors and cancer development:Evidence after 30 years of research. Clin Psychol Rev 24:315-338, 2004.

3. Lillberg K, Verkasalo PK, Kaprio J, et al: Stressful life eventsand risk of breast cancer in 10,808 women: A cohort study. AmJ Epidemiol 157:415-423, 2003.

Breast Cancer Prognosis in Relation to Family History of Breast and Ovarian Cancer Thalib L, Wedrèn S, Granath F, et al

Brit J Cancer 90:1378-1381, 2004

In this study, investigators from Sweden linked 4 national registries todetermine if women with a strong family history of breast or ovariancancer had poorer overall survival compared with women without sucha history. Sweden and other Nordic countries that have nationalizedmedicine have had the foresight to establish several national computer-ized disease registries that can be linked to rapidly answer manyhealth-related questions. The 4 registries linked in this study were theSwedish Cancer Register, which includes all cancer cases diagnosedsince 1958; the Cause of Death Register, which includes all deathssince 1952; the Multi-Generation Register, which includes all Swedishresidents with links between children and parents born after 1931 andannual updates; and the Total Population Register, which includes in-formation about births and deaths for the entire Swedish populationsince 1968. The investigators screened 20,468 women who were bornafter 1931, were alive in 1960, and were diagnosed with a primarybreast cancer between 1991 and 1998. The median follow-up for thecases was 36 months.

This study did not find an association between worse prognosisand having a family history of breast or ovarian cancer, and age at di-agnosis did not influence this lack of association. Chappuis and col-leagues1 recently reviewed 18 family history-based studies, 3 of whichwere population-based, another 3 of which were not population-based,and the remaining 12 were referral- or hospital-based. The results ofthese studies were mixed: 4 found a better prognosis with a positivefamily history, 2 showed a worse prognosis, and the other 12 showednonsignificant associations of mixed direction. The data are conflictingwith regard to whether the prognosis for women with familial or hered-itary breast cancer differs from that of women with sporadic breastcancer. Some of the discrepancies may be explained by methodologicdifferences or biases. However, no studies showed a survival advantagefor BRCA1 mutation carriers, a finding that seems to indicate thatBRCA1-related breast cancer is not associated with a survival advan-tage and that certain BRCA1 germline mutations do in fact confer aworse prognosis. Therefore, the Swedish analysis is yet another studythat did not confirm a prognostic effect for women with a family histo-ry of breast or ovarian cancer.

M. L. Bondy, PhD

Reference 1. Chappuis PO, Rosenblatt J, Foulkes WD: The influence of fa-

milial and hereditary factors on the prognosis of breast cancer.Ann Oncol 10:1163-1170, 1999.

36 Breast Diseases: A Year Book®

Quarterly36 Vol 16 No 1 2005