You are on page 1of 8

Quarterly scientific, online publication by Department of Nursing A’,

Technological Educational Institute of Athens

_REVIEW_

Breastfeeding and breast cancer


Fani Pechlivani1, Victoria Vivilaki2
1.Midwifery Lecturer, Midwifery Department, Technological Education Institution of Athens, Athens
2.Laboratory Collaborator, Midwifery Department, Technological Education Institution of Athens, Athens

ABSTRACT
Background: Several factors contribute to increase breast cancer risk including age, genes, childbearing
history, menstrual history, use of hormone therapies and socioeconomic and physical environment.
The study aimed to make a review of the articles published from 1970 to 2008 that discuss whether
breastfeeding reduces the risk of breast cancer. The review used the Pubmed database and included 25
research articles which examined the relation between breastfeeding and breast cancer.
Results from studies investigating lactation and breast cancer risk have been inconsistent. However most
studies suggest that extended period of breastfeeding during women’s life time can reduce breast cancer.
Although breastfeeding may be one factor that reduces a woman’s risk of breast cancer, it is certainly not
the only factor determining her risk.
Conclusions: Since breastfeeding is a modifiable risk factor all women should be encouraged to breastfeed
their children in order to keep themselves, their children, health systems and societies healthy.

Key words: Breastfeeding, lactation, duration of breastfeeding, breast cancer, women’s health.

CORRESPONDING AUTHOR
Fani Pechlivani,
10, Bakou Street,
New Philothei, Athens,
11524, Greece.
Tel: (+30)210-6980087, mobile: 6974772119,
Email: fpechliv@teiath.gr

INTRODUCTION

E
pidemiologic research shows that mothers breastfeed exclusively will not
breastfeeding offers mothers a menstruate for as long as they are
number of important health benefits. nursing, thus they build up their stores
Breastfeeding within the first hour of of iron and they are less likely to become
birth prevents from post birth pregnant.1 Furthermore, breastfeeding
haemorrhage, facilitates the expulsion of women return to pre birth weights more
placenta and helps uterus to return to its easily. In later life nursing mothers
prepregnancy size. Afterwards when appear to have some protection from

Page | 610
Breastfeeding and breast cancer
HEALTH SCIENCE JOURNAL®
Volume 6, Issue 4 (October – December 2012)
both breast and ovarian cancer and also of breastfeeding declined continuously in
2-4
from osteoporosis. the industrialized countries till the late
Breast cancer seems to be the second 1970s.7 In the succeeding decades many
leading cause of death among women, organizations including World Health
after lung cancer. Therefore, Organization,8 UNICEF,9 American
10
breastfeeding is one of the actions Academy of Pediatrics and American
women can take to lessen their risk for Dietetic Association11 recommended
this disease, a good practice with exclusive breastfeeding for 6 months
important public health benefits.1 It has because of its well-known advantages for
been documented, decades ago, that children, mothers, health systems and
credible mechanisms such as local effects societies.12
of breastfeeding on mammary tissue, as The lack of or short lifetime duration of
well as hormonal mechanisms dependent breastfeeding typical of women in
on the effect of lactation in changing developed countries makes a major
endocrine patterns, can be postulated to contribution to the high incidence of
explain a relationship between lactation breast cancer in these countries. More
and low breast cancer risk.5 Early in the specifically, for every year a woman
20th century, it was also noted that breastfed, her risk of developing breast
nulliparity and a history of never having cancer was reduced by 4.3%.13
breastfed were more common in women Moreover, Chang-Claude et al.,
with breast cancer than without the examined breastfeeding and breast
disease.6 cancer risk among women (of age 50) in
two geographic areas in Germany and
Prevalence and duration of breastfeeding found that prolonged breastfeeding had a
During the first 30 years of the 20th protective role against the development
century, infant nutrition was one of the of breast cancer in predominantly
main fields of paediatric research premenopausal women.14
because the importance of proper In the same year, Zheng et al.,16 found a
feeding was quite obvious. In the middle significant inverse association between
of the century infant formulae was taken duration of lactation and breast cancer
over by infant food industries and risk in Shandong Province, China.15
breastfeeding was no longer actively Also, in Iceland researchers found that
promoted. Consequently, the prevalence an inverse association was evident

Page | 611

E-ISSN: 1791-809X Health Science Journal © All rights reserved www.hsj.gr


Quarterly scientific, online publication by Department of Nursing A’,
Technological Educational Institute of Athens

between total duration of breastfeeding More studies show that lactation has a
and breast cancer. protective effect against breast cancer
In Israel breast cancer remains the major than those which show that lactation has
malignant disease among Israeli women, no effect or has a slight effect on breast
with about 4.000 new cases diagnosed cancer.
annually and a steadily increasing In Sweden and Norway a study
18
incidence rate. A hospital –based case conducted by Adami et al., found that
control study showed that short duration reproductive factors did not explain the
of lifetime breastfeeding, late age at first occurrence of breast cancer before the
breastfeeding and experience of age of 45. Thomas, Noonan and the
insufficient milk were found to increase WHO Collaborative Study of neoplasia
breast cancer risk. On the contrary, and steroid contraceptives examining
women who had ever breastfed their more than 17.000 women in 10 countries
infants were compared with females who found that long- term lactation may
had not, breastfeeding was found to be reduce slightly the risk of breast
6 22
protective. cancer.
In addition Furberg et al.,17 studying Another study conducted by Brinton et
lactation and breast cancer risk in al., stated that breastfeeding doesn’t
African- American and white women substantially reduce breast cancer risk of
residents of North Carolina found that premenopausal women (less than 45
any lactation, regardless of duration or years of age).19 However their finding
timing, was associated with a slight may reflect the fact that most of their
reduction in the risk of breast cancer study subjects breastfed only for limited
among younger and older parous periods of time.
23
women. Michels et al., also studying nearly
90.000 women found that there was no
The relation between breast cancer and important association between
breastfeeding breastfeeding and the occurrence of
The hypothesis that lactation reduces breast cancer. In addition, Coogan et
breast cancer risk has been the subject of al.,20 in their study in a South African
many debates. Results from studies of population found that lactation had little
various populations investigating or no protective effect on breast
lactation and breast cancer risk have carcinoma risk. In the study conducted
been inconsistent.2, 14, 18-21 in Southern Brazil, Tessaro et al., 24

Page | 612
Breastfeeding and breast cancer
HEALTH SCIENCE JOURNAL®
Volume 6, Issue 4 (October – December 2012)
found that breastfeeding did not have a there was a reduction in the risk of
protective effect against breast cancer. breast cancer among premenopausal
Finally, Yang et al.,25 stressed that women who have lactated but there was
previous reviews (between 1999 and no reduction in the risk of breast cancer
2007), of the association between among postmenopausal women with a
breastfeeding and breast cancer have not history of lactation.
found any consistency that breastfeeding In the United Kingdom a population
reduces risk of breast cancer. Specifically based case- control study designed to
of the 27 studies that assessed the effect investigate the relation between breast
of ever breastfeeding compared with cancer before age 36 and breastfeeding
never breastfeeding 11 found significant found that risk of breast cancer fell with
protection against breast cancer and of increasing duration of breastfeeding and
the 24 studies of the effect of with number of babies’ breastfed.28
breastfeeding duration, 13 found a A collaborative reanalysis of individual
reduced risk of breast cancer with data from 47 epidemiological studies in
extended lactation. 30 countries, including 50.302 women
Despite the demonstrated slight or no with breast cancer and 96.973 women
effect of breastfeeding on breast cancer without the disease found that the longer
there are many studies of various women breastfeed the more they are
populations which show that protected against breast cancer.13
21
breastfeeding protects either At the same time Freund et al., in
premenopausal or both premenopausal order to examine the impact of lactation
and postmenopausal women against on the risk of breast cancer carried out a
breast cancer. pub med search for publications in
26
Siskind et al., studying breast cancer English and French from 1974 through
and breastfeeding in Brisbane, Australia 2004 and found that lactation reduced
found that lactation plays a modest the risk for breast cancer and that this
direct or indirect part in reducing the protective effect seemed greater for
risk of breast cancer for both women who had extended periods of
premenopausal and postmenopausal breastfeeding during their lifetime,
women. Newcomb et al.,27 also studying particularly in case of BRCA1 mutation.
29
the effect of lactation to premenopausal Recently, Huo et al., focusing on
and post menopausal women found that Nigerian women found that parity and

Page | 613

E-ISSN: 1791-809X Health Science Journal © All rights reserved www.hsj.gr


Quarterly scientific, online publication by Department of Nursing A’,
Technological Educational Institute of Athens

breastfeeding are protective against predominantly a disease diagnosed in


breast cancer. More specifically breast older women, as the age limit of the
cancer risk decreased by 7% for every 12 population increases the incidence of
months of breastfeeding. Breast cancer breast cancer is also expected to
tented to occur more frequently in the increase. If women begin to make
higher socio-economic groups and since changes in their lifestyle now, such as to
women in such groups lactate less, it reduce the use of hormone replacement
might have been expected that the therapy, to maintain normal body
patients would have had shorter total weight, to increase levels of physical
periods of lactation on this basis alone.5 activity, to limit alcohol use and to
30
It was stressed by Lipworth et al., also breastfeed for six months then by 2024
that some problems of methodology one in 10 cases could be prevented. 32
could be carefully avoided. In some Women should also be informed that the
studies were used «average breastfeeding risk for premenopausal breast cancer is
per child of 30 weeks», «ever reduced with lactation and that this
breastfeeding compared with never protective effect seems to be best for
breastfeeding», «exclusive breastfeeding women who have extended period of
and breast feeding that was breastfeeding during their lifetime.
supplemented with formula». Exclusive Women with familial risks could
breastfeeding and duration of potentially benefit most from
breastfeeding seem to play important breastfeeding. Since breast milk is the
roles in the understanding of underling ideal nutrient for the newborn, and since
mechanisms for health protection. 31 It is breastfeeding is a modifiable risk factor,
however of utmost importance that all women should be encouraged to
breastfeeding patterns are classified in breastfeed their children.33
epidemiologic studies of mothers’ Finally, further research is needed to
health.4 identify lifestyle or other exogenous
determinants of pregnancy hormone
Breast cancer is preventable levels, as well as possible mechanisms by
It is important to recognise that overall which they may influence carcinogenic
an individual’s risk of cancer is a processes in the breast and possibly
combination of genetic determinants, as other organs.30
well as lifestyle and environmental
factors. Since breast cancer is

Page | 614
Breastfeeding and breast cancer
HEALTH SCIENCE JOURNAL®
Volume 6, Issue 4 (October – December 2012)
Conclusion Current and proposed
Research shows that a number of factors recommendations, rationale,
work together to increase or decrease prevalence, duration and trends.
breast cancer risk- including age, genes, Publ Health Nutr 2001; 4: 631-45.
childbearing history, menstrual history 5.MacMahon B, Lin TM, Lowe CR,
and use of hormone therapies. Various Mirra AP, Ravnihar B, Salber EJ et
psychopathological mechanisms are al. Lactation and cancer of the
involved in the protective effect of breast: A summary of an
breastfeeding and especially anovulation international study. Bull World
and cellular differentiation of the Health Organ 1970; 42: 185-94.
mammary cells. While breastfeeding is a 6.Shema L, Ore L, Ben-Shachar M,
potentially modifiable behaviour, the Haj M, Linn S. The association
practical implication of reduced breast between breastfeeding and breast
cancer risk among women with cancer occurrence among Israeli
prolonged durations of breastfeeding Jewish women: A case control
may be of great importance particularly study. J Cancer Res Clin Oncol
in Western societies. 2007; 133: 539-46.
7.Zetterstrom R. Trends in research
on infant nutrition, past, present
REFERENCES and future. Acta Paediatr 1994;
1.Eiger MS, Wendkos Olds S. The 402(Suppl): 1-3.
complete book of breastfeeding. 8.World Health Organization. Global
New York: Workman; 1999. data bank on breastfeeding.
2.Baumslag N, Michels DL. Milk, Geneva: WHO; 1996.
money and madness. The culture 9.World Health
and politics of breastfeeding. Organization/UNICEF. Indicators
London: Bergin & Carvey; 1995. for assessing health facility
3.Renfrew M, Fisher C, Arms S. practices that affect breastfeeding.
Breastfeeding. California: Celestial Geneva: WHO; 1993.
Arts; 2004. 10.American Academy of Pediatrics.
4.Yngve A, Sjöström M. Workgroup on breastfeeding,
Breastfeeding in countries of the breastfeeding and the use of
European Union and EFTA:

Page | 615

E-ISSN: 1791-809X Health Science Journal © All rights reserved www.hsj.gr


Quarterly scientific, online publication by Department of Nursing A’,
Technological Educational Institute of Athens

human milk. Pediatrics 1999; 100: T, Tulinius H et al. Breastfeeding


1035-9. and reduced risk of breast cancer
11.American Dietetic Association in an Icelandic cohort study. Am J
Promotion of Breastfeeding- Epidemiol 2001; 154: 975-7.
Position of ADA. J Am Diet Assoc 17.Furberg H, Newman B, Moorman
1997; 97: 626-66. P, Millikan R. Lactation and breast
12.Cattaneo A, Davanzo R, Ronfani L. cancer risk. Int J Epidemiol 1999;
Are data on prevalence and 28: 396-402.
duration of breastfeeding reliable? 18.Adami HO, Bergström R, Lund E,
The case of Italy. Acta Paediatr Meirik O. Absence of association
2000; 89: 88-93. between reproductive variables
13.Collaborative Group on Hormonal and the risk of breast cancer in
Factors in Breast Cancer. Breast young women in Sweden and
cancer and breastfeeding: Norway. Br J Cancer 1990; 62:
Collaborative reanalysis of 122-6.
individual data from 47 19.Brinton LA, Potischman NA,
epidemiological studies in 30 Swanson CA, Schoenberg JB,
countries, including 50.302 Coates RJ, Gammon MD et al.
women with breast cancer and Breastfeeding and breast cancer
96.973 women without the risk. Cancer Causes Control 1995;
disease. Lancet 2002; 360: 187-95. 6: 199-208.
14.Chang-Claude J, Eby N, Kiechle M, 20.Coogan PF, Rosenberg L, Shapiro
Bastert G, Becher H. Breastfeeding S, Hoffman M. Lactation and
and breast cancer risk by age 50 breast carcinoma risk in a South
among women in Germany. African population. Cancer 1999;
Cancer Causes Control 2000; 11: 86: 982-9.
687-95. 21.Freund C, Mirabel L, Annane K,
15.Zheng T, Duan L, Zhang B, Wang Mathelin C. Breastfeeding and
Y, Chen Y, Zhang Y et al. Lactation breast cancer. Gynecol Obstet
reduces breast cancer risk in Fertil 2005; 33: 739-49.
Shandong Province, China. Am J 22.Thomas DB, Noonan EA, the WHO
Epidemiol 2000; 152: 1129-35. Collaborative Study of Neoplasia
16.Thomas DB, Rosenblatt KA, Ray and Steroid Contraceptives. Breast
RM, Tryggvadóttir L, Sigurvinsson

Page | 616
Breastfeeding and breast cancer
HEALTH SCIENCE JOURNAL®
Volume 6, Issue 4 (October – December 2012)
cancer and prolonged lactation. Breastfeeding and risk of breast
Int J Epidemiol 1993; 22: 619-26. cancer in young women. Br Med J
23.Michels KB, Willett WC, Rosner 1993; 307: 17-20.
BA, Manson JE, Hunter DJ, Colditz 29.Huo D, Adebamowo CA,
GA et al. Prospective assessment Ogundiran TO, Akang EE,
of breastfeeding and breast cancer Campbell O, Adenipekum A et al.
incidence among 89.887 women. Parity and breastfeeding are
Lancet 1996; 347: 431-6. protective against breast cancer in
24.Tessaro S, Béria JU, Tomasi E, Nigerian women. Br J Cancer
Victora CG. Breastfeeding and 2008; 98: 992-6.
breast cancer: A case-control 30.Lipworth L, Bailey LR,
study in Southern Brazil. Cad de Trichopoulos D. History of
Saude Publica 2003; 19: 1593- breastfeeding in relation to breast
1601. cancer risk: A review of the
25.Yang L, Jacobsen KH. A epidemiologic literature. J Natl
systematic review of the Cancer Inst 2000; 92: 302-12.
association between breastfeeding 31.Heinig MJ, Dewey KG. Health
and breast cancer. J Women’s effect of breastfeeding for
Health 2008; 17: 1635-45. mothers: A critical review. Nutr
26.Siskind V, Schofield F, Rice D, Res Rev 1997; 10: 35-56.
Bain C. Breast cancer and 32.National Cancer Research
breastfeeding: Results from an Institute. [Homepage on the
Australian case-control study. Am Internet].UK: Lifestyle changes
J Epidemiol 1989; 130: 229-36. could prevent one in ten cases of
27.Newcomb PA, Storer BE, breast cancer by 2024. Retrieved
Longnecker MP, Mittendorf R, on 20/12/2008. Available from:
Greenberg ER, Clapp RW et al. http://www.ncri.org.uk.
Lactation and a reduced risk of 33.Helewa M, Lévesque P, Provencher
premenopausal breast cancer. N D, Lea RH, Rosolowich V, Shapiro
Engl J Med 1994; 330: 81-7. HM. Breast cancer, pregnancy, and
28.United Kingdom National Case- breastfeeding. J Obstet Gynaecol
Control Study Group. Can 2002; 24: 164-180.

Page | 617

E-ISSN: 1791-809X Health Science Journal © All rights reserved www.hsj.gr