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    Original Investigation
    Public Health
    March 13, 2020

    Trends in Parity and Breast Cancer Incidence in US Women Younger Than 40 Years From 1935 to 2015

    Author Affiliations
    • 1Mailman School of Public Health, Department of Epidemiology, Columbia University, New York, New York
    • 2Connecticut Tumor Registry, Connecticut Department of Public Health, Hartford
    • 3Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
    JAMA Netw Open. 2020;3(3):e200929. doi:10.1001/jamanetworkopen.2020.0929
    Key Points español 中文 (chinese)

    Question  Can the increase in breast cancer incidence in US women aged 25 to 39 years be explained by trends of decreasing parity?

    Findings  In this population-based cohort study including Connecticut women aged 25 to 39 from 1935 to 2015, breast cancer incidence statistically significantly increased by 0.65% per year; after considering parity trends, the annual increase was of similar magnitude and therefore could not explain the trends in breast cancer.

    Meaning  These findings suggest that secular trends in parity cannot explain the increasing incidence rate of breast cancer in young women, and this increase cannot be primarily attributed to mammography screening, as the trend analysis shows the increase started prior to screening.


    Importance  During the past several decades, breast cancer incidence has been increasing for women younger than 40 years. The increase matches the decrease in parity, an established breast cancer risk factor, but secular trends in incidence have not been examined prior to the 1970s.

    Objective  To examine whether secular trends in parity explain the increase in breast cancer incidence among US women aged 25 to 39 years from 1935 to 2015.

    Design, Setting, and Participants  This population-based cohort study used population-based aggregate-level data from the Connecticut Tumor Registry (CTR) to examine breast cancer incidence and age-standardized rates among women aged 25 to 39 years from 1935 to 2015. National mean live births were calculated using birth data from the National Vital Statistics System (NVSS) from 1930 to 2015 (allowing for 5-year lag). Linear regression was used to compare a baseline model of year estimating age-adjusted breast cancer incidence rate with a model that adjusted for parity constructs.

    Main Outcomes and Measures  Breast cancer incidence rates among women aged 25 to 39 years from 1935 to 2015.

    Results  Among women in Connecticut aged 25 to 39 years from 1935 to 2015, incidence of breast cancer for women aged 25 to 39 years increased 0.65% (95% CI, 0.53%-0.77%) per year, from 16.3 breast cancer diagnoses per 100 000 women in 1935 to 38.5 breast cancer diagnoses per 100 000 women in 2015. This increase began nearly 4 decades before the secular decrease in parity (mean [SD] parity peaked at 2.26 [0.87] live births per woman in 1966 and in 2010 had decreased to 1.41 [0.71] live births per woman). Age-specific parity trends explained only 0% to 4% of the variability in incidence over time.

    Conclusion and Relevance  These findings suggest that breast cancer incidence for women aged 25 to 39 years has been significantly increasing since the 1930s and cannot be attributed to changes in parity over time.