Association Between Breastfeeding and Ovarian Cancer Risk
Authors: Ana Babic, Naoko Sasamoto, Bernard A. Rosner, Shelley S. Tworoger, Susan J. Jordan, Harvey A. Risch, Holly R. Harris, Mary Anne Rossing, Jennifer A. Doherty, Renée T. Fortner, Jenny Chang-Claude, Marc T. Goodman, Pamela J. Thompson, Kirsten B. Moysich, Roberta B. Ness, Susanne K. Kjaer, Allan Jensen, Joellen M. Schildkraut, Linda J. Titus, Daniel W. Cramer, Elisa V. Bandera, Bo Qin, Weiva Sieh, Valerie McGuire, Rebecca Sutphen, Celeste L. Pearce, Anna H. Wu, Malcolm Pike, Penelope M. Webb, Francesmary Modugno, Kathryn L. Terry
Journal: JAMA Oncology (2020)

<h3>Importance</h3> Breastfeeding has been associated with a reduced risk of epithelial ovarian cancer in multiple studies, but others showed no association. Whether risk reduction extends beyond that provided by pregnancy alone or differs by histotype is unclear. Furthermore, the observed associations between duration and timing of breastfeeding with ovarian cancer risk have been inconsistent. <h3>Objective</h3> To determine the association between breastfeeding (ie, ever/never, duration, timing) and ovarian cancer risk overall and by histotype. <h3>Design, Setting, and Participants</h3> A pooled analysis of parous women with ovarian cancer and controls from 13 case-control studies participating in the Ovarian Cancer Association Consortium was performed. Odds ratios (ORs) and 95% CIs of the overall association were calculated using multivariable logistic regression and polytomous logistic regression for histotype-specific associations. All data were collected from individual sites from November 1989 to December 2009, and analysis took place from September 2017 to July 2019. <h3>Exposures</h3> Data on breastfeeding history, including duration per child breastfed, age at first and last breastfeeding, and years since last breastfeeding were collected by questionnaire or interview and was harmonized across studies. <h3>Main Outcomes and Measures</h3> Diagnosis of epithelial ovarian cancer. <h3>Results</h3> A total of 9973 women with ovarian cancer (mean [SD] age, 57.4 [11.1] years) and 13 843 controls (mean [SD] age, 56.4 [11.7] years) were included. Breastfeeding was associated with a 24% lower risk of invasive ovarian cancer (odds ratio [OR], 0.76; 95% CI, 0.71-0.80). Independent of parity, ever having breastfed was associated with reduction in risk of all invasive ovarian cancers, particularly high-grade serous and endometrioid cancers. For a single breastfeeding episode, mean breastfeeding duration of 1 to 3 months was associated with 18% lower risk (OR, 0.82; 95% CI, 0.76-0.88), and breastfeeding for 12 or more months was associated with a 34% lower risk (OR, 0.66; 95% CI, 0.58-0.75). More recent breastfeeding was associated with a reduction in risk (OR, 0.56; 95% CI, 0.47-0.66 for &lt;10 years) that persisted for decades (OR, 0.83; 95% CI, 0.77-0.90 for ≥30 years;<i>P</i>for trend = .02). <h3>Conclusions and Relevance</h3> Breastfeeding is associated with a significant decrease in risk of ovarian cancer overall and for the high-grade serous subtype, the most lethal type of ovarian cancer. The findings suggest that breastfeeding is a potentially modifiable factor that may lower risk of ovarian cancer independent of pregnancy alone.