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Breast cancer risk increases by 3% for each year older a woman is when she first gives birth, a meta-analysis showed. The association may be limited to ER/PR-positive tumours.[2-4] ER/PR-positive breast cancer risk is 15% higher in women who first gave birth at an older age, compared with those who did so at a younger age, a meta-analysis showed. HER2-positive and triple-negative breast cancers are not associated with age at first birth. Conversely among BRCA1 mutation carriers, breast cancer risk may be lower in those who are older at first birth, meta-analyses have shown;[5,6] among BRCA2 carriers, breast cancer risk is not associated with age at first birth.[5,6] Breast cancer risk increases by 5% for each year younger at menarche (first menstrual period), a meta-analysis has shown. The association is stronger for oestrogen receptor (ER)-positive and progesterone receptor (PR)-positive tumours than for ER- and PR-negative tumours. Breast cancer risk may be higher in women whose breast development started at a younger age, a cohort study indicates. Among BRCA1 mutation carriers too, breast cancer risk may be higher in those who are younger at menarche, a meta-analysis showed; among BRCA2 carriers, breast cancer risk is not associated with age at menarche.[5,6] Breast cancer risk increases by around 3% for each year older at menopause, a meta-analysis has shown. Post-menopausal women (natural menopause or induced by surgery) have a lower risk of breast cancer than pre-menopausal women of the same age and childbearing pattern, a meta-analysis showed. Reproductive organ surgery Breast cancer risk is not associated with tubal sterilisation, a meta-analysis showed. Breast cancer risk is 24-41% lower in women who have hysterectomy and oophorectomy before menopause, compared with women who do not have these surgeries, a pooled analysis and case-control study showed.[10,11] Hysterectomy and oophorectomy after menopause may be associated with increased breast cancer risk if oestrogen therapy is used after the surgery, a pooled analysis showed. Breast cancer risk decreases by 7% with each live birth, meta-analyses have shown.[1,2] Breast cancer risk may not be associated with twin pregnancy, a meta-analysis showed. ER/PR-positive breast cancer risk is 25% lower in women who have had children compared with those who have not, a meta-analysis showed. HER2-positive and triple-negative breast cancer is not associated with parity. The association between parity and breast cancer may vary by tumour types, with the largest risk reduction for mucinous tumours, and a risk increase for medullary tumours, a cohort study indicates. Conversely among BRCA1/2 mutation carriers, breast cancer risk is not associated with parity, one meta-analysis showed, though another showed a decreased risk with higher parity. International Agency for Research on Cancer (IARC) classifies the role of this risk factor in cancer development. An estimated 1% of female breast cancers in the UK are linked to oral contraceptives (OCs); because breast cancer risk is generally low in the OC-using population (typically younger women), OC-related risk contributes a relatively small number of additional cases. OCs contain synthetic sex hormones, which may explain the link between OC use and breast cancer risk.
Current users of OCs have around 24% higher breast cancer risk compared to never users, a meta-analysis showed. However, breast cancers in OC users tend to be less advanced compared with those in OC never-users. The relative risk of breast cancer declines after OC cessation, such that 10 years after cessation no excess risk remains.[3,4] Breast cancer risk does not appear to increase with longer duration of OC use,[3,4] however, younger age at first OC use is associated with a larger increase in breast cancer risk. The risk associated with OC use appears to be similar across OC formulations (which have changed considerably over time), family history, BRCA carrier status (though some evidence of no association with OC use in BRCA1/2 mutation carriers), and ethnicity.[3,5,6] See IARC's classifications on the role of this risk factor Find out more about the definitions and evidence for this data Learn how attributable risk is calculated View our health information on hormones and cancer International Agency for Research on Cancer (IARC) classifies the role of this risk factor in cancer development. Hormone replacement therapy (HRT) contains synthetic sex hormones, which may explain the link between HRT use and breast cancer risk.
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BRCA1 and BRCA2 mutations are uncommon, though this varies by ethnicity/country of origin. They affect an estimated 0.11% and 0.12% of the general population respectively, equating to around 1 in 450 women carrying a mutation.
This largely reflects cell DNA damage accumulating over time.
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