Grand multiparity and reproductive cancer in the Jerusalem Perinatal Study Cohort

Objectives: Grand multiparity is associated with reduced mortality from reproductive cancers. We aimed to separate the components of mortality, by measuring incidence of and survival after reproductive cancer onset in grand multiparous compared to other parous women. Study design: We linked data from the population-based Jerusalem Perinatal Study Cohort, which included women aged 13–55 who delivered 1964–1976, with Israel’s National Cancer Registry. We compared breast and gynecologic cancer risk and all-cause survival following a cancer diagnosis, among grand multiparae (GMPs = parity 5+, n = 8,246) versus women with parity 1–4 (n = 19,703), adjusting for reproductive and demographic variables. Results: Grand multiparae were at significantly lower risk of breast cancer than others (adjusted hazard ratio (HR_adj) = 0.62, 95 % confidence interval (CI) 0.54–0.71), after controlling for age at first birth, education, and other covariates. This reduction was greater among GMPs whose first birth occurred after age 30 (p-interaction = 0.0001) and for cancer occurring before age 50 years (p = 0.002). In contrast, GMPs were at greater risk of death than women with parity <5, following a breast cancer diagnosis (HR_adj = 1.69, CI 1.39–2.1). Ovarian, uterine, and cervical cancer incidence did not differ between the groups, but survival was reduced for GMPs with uterine cancer (HR_adj = 2.48, CI 1.22–5.03). Conclusion: Reduced reproductive cancer mortality reported among GMPs masks two opposing phenomena: decreased breast cancer risk and poorer survival after breast and uterine cancers. The latter unfavorable outcome suggests that tumors in GMPs may be particularly aggressive, having perhaps escaped protective mechanisms conferred by parity. This finding calls for heightened clinical attention in this group.