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Br J Cancer. 1996 March; 73(5): 680–686.
PMCID: PMC2074339

Menstrual and reproductive factors and risk of breast cancer in Asian-Americans.


We conducted a population-based case-control study of breast cancer among Chinese-, Japanese- and Filipino-American women in Los Angeles County Metropolitan Statistical Area (MSA), San Francisco-Oakland MSA and Oahu, Hawaii. One objective of the study was to quantify breast cancer risks in relation to menstrual and reproductive histories in migrant and US-born Asian-Americans and to establish whether the gradient of risk in Asian-Americans can be explained by these factors. Using a common study design and questionnaire in the three study areas, we successfully conducted in-person interviews with 597 Asian-American women diagnosed with incident, primary breast cancer during the period 1983-87 (70% of those eligible) and 966 population-based controls (75% of those eligible). Controls were matched to cases on age, ethnicity and area of residence. In the present analysis, which included 492 cases and 768 controls, we observed a statistically non-significant 4% reduction in risk of breast cancer with each year delay in onset of menstruation. Independent of age at menarche risk of breast cancer was lower (odds ratio; OR=0.77) among women with menstrual cycles greater than 29 days. Parous Asian-American women showed a significantly lower risk of breast cancer then nulliparous women (OR=0.54). An increasing number of livebirths and a decreasing age at first livebirth were both associated with a lower risk of breast cancer, although the effect of number of livebirths was no longer significant after adjustment for age at first livebirth. Women with a pregnancy (spontaneous or induced abortions) but no livebirth had a statistically non-significant increased risk (OR=1.84), but there was no evidence that one type of abortion was particularly harmful. A positive history of breastfeeding was associated with non-significantly lower risk of breast cancer (OR=.78). There are several notable differences in the menstrual and reproductive factors between Asian-Americans in this study and published data on US whites. US-born Asian Americans had an average age at menarche of 12.12 years-no older than has been found in comparable studies of US whites, but 1.4 years earlier than Asian women who migrated to the US. Asian-American women, particularly those born in the US and those who migrated before age 36, also had a later age at first birth and fewer livebirths than US whites. A slightly higher proportion of Asian-American women breastfed, compared with US whites. The duration of breastfeeding was similar in US-born Asians and US whites, but was longer in Asian migrants, especially those who migrated at a later age. Menstrual and reproductive factors in Asian-American women are consistent with their breast cancer rates being at least as high as in US whites, and they are. However, the effects of these menstrual and reproductive factors were small and the ORs for migration variables changed only slightly after adjustment for these menstrual and reproductive factors. These results suggest that the lower rates of breast cancer in Asians must be largely as a result of other environmental/lifestyle factors.

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  • Vihko R, Apter D. Endocrine characteristics of adolescent menstrual cycles: impact of early menarche. J Steroid Biochem. 1984 Jan;20(1):231–236. [PubMed]
  • Apter D, Reinilä M, Vihko R. Some endocrine characteristics of early menarche, a risk factor for breast cancer, are preserved into adulthood. Int J Cancer. 1989 Nov 15;44(5):783–787. [PubMed]
  • Bernstein L, Pike MC, Ross RK, Henderson BE. Age at menarche and estrogen concentrations of adult women. Cancer Causes Control. 1991 Jul;2(4):221–225. [PubMed]
  • Brinton LA, Hoover R, Fraumeni JF., Jr Reproductive factors in the aetiology of breast cancer. Br J Cancer. 1983 Jun;47(6):757–762. [PMC free article] [PubMed]
  • Bruzzi P, Negri E, La Vecchia C, Decarli A, Palli D, Parazzini F, Del Turco MR. Short term increase in risk of breast cancer after full term pregnancy. BMJ. 1988 Oct 29;297(6656):1096–1098. [PMC free article] [PubMed]
  • Daling JR, Malone KE, Voigt LF, White E, Weiss NS. Risk of breast cancer among young women: relationship to induced abortion. J Natl Cancer Inst. 1994 Nov 2;86(21):1584–1592. [PubMed]
  • Ewertz M, Duffy SW, Adami HO, Kvåle G, Lund E, Meirik O, Mellemgaard A, Soini I, Tulinius H. Age at first birth, parity and risk of breast cancer: a meta-analysis of 8 studies from the Nordic countries. Int J Cancer. 1990 Oct 15;46(4):597–603. [PubMed]
  • Henderson BE, Pike MC, Casagrande JT. Breast cancer and the oestrogen window hypothesis. Lancet. 1981 Aug 15;2(8242):363–364. [PubMed]
  • Henderson BE, Ross RK, Judd HL, Krailo MD, Pike MC. Do regular ovulatory cycles increase breast cancer risk? Cancer. 1985 Sep 1;56(5):1206–1208. [PubMed]
  • Thein-Hlaing, Thein-Maung-Myint Risk factors of breast cancer in Burma. Int J Cancer. 1978 Apr 15;21(4):432–437. [PubMed]
  • Hoel DG, Wakabayashi T, Pike MC. Secular trends in the distributions of the breast cancer risk factors--menarche, first birth, menopause, and weight--in Hiroshima and Nagasaki, Japan. Am J Epidemiol. 1983 Jul;118(1):78–89. [PubMed]
  • Hsieh CC, Trichopoulos D, Katsouyanni K, Yuasa S. Age at menarche, age at menopause, height and obesity as risk factors for breast cancer: associations and interactions in an international case-control study. Int J Cancer. 1990 Nov 15;46(5):796–800. [PubMed]
  • Kalache A, Maguire A, Thompson SG. Age at last full-term pregnancy and risk of breast cancer. Lancet. 1993 Jan 2;341(8836):33–36. [PubMed]
  • Kelsey JL, Gammon MD, John EM. Reproductive factors and breast cancer. Epidemiol Rev. 1993;15(1):36–47. [PubMed]
  • Kvåle G. Reproductive factors in breast cancer epidemiology. Acta Oncol. 1992;31(2):187–194. [PubMed]
  • La Vecchia C, Decarli A, di Pietro S, Franceschi S, Negri E, Parazzini F. Menstrual cycle patterns and the risk of breast disease. Eur J Cancer Clin Oncol. 1985 Apr;21(4):417–422. [PubMed]
  • La Vecchia C, Decarli A, Parazzini F, Gentile A, Negri E, Cecchetti G, Franceschi S. General epidemiology of breast cancer in northern Italy. Int J Epidemiol. 1987 Sep;16(3):347–355. [PubMed]
  • Layde PM, Webster LA, Baughman AL, Wingo PA, Rubin GL, Ory HW. The independent associations of parity, age at first full term pregnancy, and duration of breastfeeding with the risk of breast cancer. Cancer and Steroid Hormone Study Group. J Clin Epidemiol. 1989;42(10):963–973. [PubMed]
  • Lee HP, Gourley L, Duffy SW, Estève J, Lee J, Day NE. Risk factors for breast cancer by age and menopausal status: a case-control study in Singapore. Cancer Causes Control. 1992 Jul;3(4):313–322. [PubMed]
  • MacMahon B, Cole P, Lin TM, Lowe CR, Mirra AP, Ravnihar B, Salber EJ, Valaoras VG, Yuasa S. Age at first birth and breast cancer risk. Bull World Health Organ. 1970;43(2):209–221. [PubMed]
  • MacMahon B, Purde M, Cramer D, Hint E. Association of breast cancer risk with age at first and subsequent births: a study in the population of the Estonian Republic. J Natl Cancer Inst. 1982 Nov;69(5):1035–1038. [PubMed]
  • Newcomb PA, Storer BE, Longnecker MP, Mittendorf R, Greenberg ER, Clapp RW, Burke KP, Willett WC, MacMahon B. Lactation and a reduced risk of premenopausal breast cancer. N Engl J Med. 1994 Jan 13;330(2):81–87. [PubMed]
  • Olsson H, Landin-Olsson M, Gullberg B. Retrospective assessment of menstrual cycle length in patients with breast cancer, in patients with benign breast disease, and in women without breast disease. J Natl Cancer Inst. 1983 Jan;70(1):17–20. [PubMed]
  • Paffenbarger RS, Jr, Kampert JB, Chang HG. Characteristics that predict risk of breast cancer before and after the menopause. Am J Epidemiol. 1980 Aug;112(2):258–268. [PubMed]
  • Parazzini F, La Vecchia C, Negri E. Spontaneous and induced abortions and risk of breast cancer. Int J Cancer. 1991 Jul 30;48(6):816–820. [PubMed]
  • Pike MC, Henderson BE, Casagrande JT, Rosario I, Gray GE. Oral contraceptive use and early abortion as risk factors for breast cancer in young women. Br J Cancer. 1981 Jan;43(1):72–76. [PMC free article] [PubMed]
  • Pike MC, Krailo MD, Henderson BE, Casagrande JT, Hoel DG. 'Hormonal' risk factors, 'breast tissue age' and the age-incidence of breast cancer. Nature. 1983 Jun 30;303(5920):767–770. [PubMed]
  • Remennick LI. Induced abortion as cancer risk factor: a review of epidemiological evidence. J Epidemiol Community Health. 1990 Dec;44(4):259–264. [PMC free article] [PubMed]
  • Rosenberg L. Induced abortion and breast cancer: more scientific data are needed. J Natl Cancer Inst. 1994 Nov 2;86(21):1569–1570. [PubMed]
  • Rosero-Bixby L, Oberle MW, Lee NC. Reproductive history and breast cancer in a population of high fertility, Costa Rica, 1984-85. Int J Cancer. 1987 Dec 15;40(6):747–754. [PubMed]
  • Soini I. Risk factors of breast cancer in Finland. Int J Epidemiol. 1977 Dec;6(4):365–373. [PubMed]
  • Talamini R, La Vecchia C, Franceschi S, Colombo F, Decarli A, Grattoni E, Grigoletto E, Tognoni G. Reproductive and hormonal factors and breast cancer in a Northern Italian population. Int J Epidemiol. 1985 Mar;14(1):70–74. [PubMed]
  • Tao SC, Yu MC, Ross RK, Xiu KW. Risk factors for breast cancer in Chinese women of Beijing. Int J Cancer. 1988 Oct 15;42(4):495–498. [PubMed]
  • Tulinius H, Sigvaldason H, Hrafnkelsson J, Olafsdóttir G, Tryggvadóttir L, Sigurthsson K. Reproductive factors and breast cancer risk in Iceland. A second cohort study. Int J Cancer. 1990 Dec 15;46(6):972–975. [PubMed]
  • Wang QS, Ross RK, Yu MC, Ning JP, Henderson BE, Kimm HT. A case-control study of breast cancer in Tianjin, China. Cancer Epidemiol Biomarkers Prev. 1992 Sep-Oct;1(6):435–439. [PubMed]
  • Williams EM, Jones L, Vessey MP, McPherson K. Short term increase in risk of breast cancer associated with full term pregnancy. BMJ. 1990 Mar 3;300(6724):578–579. [PMC free article] [PubMed]
  • Yoo KY, Tajima K, Kuroishi T, Hirose K, Yoshida M, Miura S, Murai H. Independent protective effect of lactation against breast cancer: a case-control study in Japan. Am J Epidemiol. 1992 Apr 1;135(7):726–733. [PubMed]
  • Yuan JM, Yu MC, Ross RK, Gao YT, Henderson BE. Risk factors for breast cancer in Chinese women in Shanghai. Cancer Res. 1988 Apr 1;48(7):1949–1953. [PubMed]
  • Ziegler RG, Hoover RN, Pike MC, Hildesheim A, Nomura AM, West DW, Wu-Williams AH, Kolonel LN, Horn-Ross PL, Rosenthal JF, et al. Migration patterns and breast cancer risk in Asian-American women. J Natl Cancer Inst. 1993 Nov 17;85(22):1819–1827. [PubMed]

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