Nulliparity, decade of first birth, and breast cancer in Connecticut cohorts, 1855 to 1945: An ecological study

Risk of breast cancer increases with age at first birth, and is lower in women who bear their first children while young than in nulliparous women. While previous studies have investigated risk of breast cancer in birth cohorts by examining partial aspects of cohort childbearing, the present ecological study assesses total cohort childbearing risk in Connecticut women born between 1855 and 1945. In each cohort, the proportion of women nulliparous and first bearing children in their twenties, thirties, and forties are weighted by relative risks associated with these events as ascertained in previous studies. Summed cohort childbearing risks are compared to the incidence of breast cancer in women 40 years of age and older in the same cohorts. Changes in decade of first birth and nulliparity do not explain the changes in breast cancer incidence observed: while cohort childbearing risk has declined over the period examined, breast cancer incidence has increased in the same cohorts. Alternative explanations for cohort increases in breast cancer incidence are reviewed.