Factors associated with breast disorders detected by clinical breast examination during pregnancy and six months postpartum in Ibadan, South-western Nigeria

Accepted: 25 April 2022
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Background. Breast disorders (BD) during pregnancy and postpartum cause anxiety and reduce women’s quality of life. The study examined BD risk factors during pregnancy and six months after delivery.
Methods. Women attending antenatal clinics at 26 weeks gestation were recruited. 1248 pregnant women were followed six months postpartum. During recruitment, a validated questionnaire was used to collect participant characteristics and risk factors. Palpable lumps, inflammation, persistent pain, and abnormal nipple discharge were classified breast disorders. Statistical analysis used multiple logistic and cox regression models at p<0.05.
Results. Women with benign breast disease were more likely to develop BD (aOR = 2.63, 95% CI = 1.50–4.88). One pregnancy increases the risk of BD more than three times (aOR=0.52, 95%CI: 0.29–0.95). History of breast trauma (aHR=3.59, 95%CI: 1.40–9.17) and 3 miscarriages vs. none (aHR=2.23, 95%CI: 1.04–4.23) were also risk factors for BD. The second quartile of physical activity was associated with a lower risk of BD (aHR=0.35, 95%CI: 0.15–0.78).
Conclusion. Women with breast trauma and miscarriage are more likely to develop breast disorders during pregnancy and six months after delivery. Our findings highlight the need for additional longitudinal research to validate these findings and plans for prevention and control.
World Health Organization. International statistical classification of diseases and related health problems. Icd version 10. 5th ed. Geneva, Switzerland: WHO, 2016. https://icd.who.int/browse10/2016/en
Bell H, Peters G, Lynch A, et al. Breast disorders during pregnancy and lactation: The differential diagnoses. Journal of Clinical Gynecology and Obstetrics. 2013; 2: 47-50. DOI: https://doi.org/10.4021/jcgo140w
Adeniji-Sofoluwe AT, Obajimi GO and Obajimi MO. Pregnancy related breast diseases in a developing african country: Initial sonographic evaluation. Pan African Medical Journal. 2015; 20: 239. http://www.ncbi.nlm.nih.gov/pubmed/27386035 DOI: https://doi.org/10.11604/pamj.2015.20.239.4830
Langer A, Mohallem M, Berment H, et al. Breast lumps in pregnant women. Diagnostic and interventional imaging. 2015; 96: 1077-87. http://www.ncbi.nlm.nih.gov/pubmed/26341843 DOI: https://doi.org/10.1016/j.diii.2015.07.005
Lukanova A, Surcel HM, Lundin E, et al. Circulating estrogens and progesterone during primiparous pregnancies and risk of maternal breast cancer. International Journal of Cancer. 2012; 130: 910-20. http://www.ncbi.nlm.nih.gov/pubmed/21413009 DOI: https://doi.org/10.1002/ijc.26070
Yu JH, Kim MJ, Cho H, et al. Breast diseases during pregnancy and lactation. Obstetric and Gynecological Science. 2013; 56: 143-59. http://www.ncbi.nlm.nih.gov/pubmed/24327995 DOI: https://doi.org/10.5468/ogs.2013.56.3.143
Joshi S, Dialani V, Marotti J, et al. Breast disease in the pregnant and lactating patient: Radiological-pathological correlation. Insights into imaging. 2013; 4: 527-38. http://www.ncbi.nlm.nih.gov/pubmed/23881348 DOI: https://doi.org/10.1007/s13244-012-0211-y
Pena GG, Maia YC, Mendes MC, et al. Physical activity is associated with malignant and benign breast diseases in low-income brazilian women. Nutrition and cancer. 2014; 66: 707-15. http://www.ncbi.nlm.nih.gov/pubmed/24070266 9.Frienderich CM, Bryant HE, Alexander F, et al. Risk factors for benign proliferative breast disease. International Journal of Epidemiology. 2000; 29: 637-44. DOI: https://doi.org/10.1080/01635581.2013.801997
Hartmann LC, Sellers TA, Frost MH, et al. Benign breast disease and the risk of breast cancer. The New England Journal of Medicine. 2005; 353: 229-37. DOI: https://doi.org/10.1056/NEJMoa044383
Ali SA, Gupta S, Sehgal R, et al. Survival outcomes in pregnancy associated breast cancer: A retrospective case control study. The breast journal. 2012; 18: 139-44. http://www.ncbi.nlm.nih.gov/pubmed/22356297 DOI: https://doi.org/10.1111/j.1524-4741.2011.01201.x
Lee GE, Mayer EL and Partridge A. Prognosis of pregnancy-associated breast cancer. Breast cancer research and treatment. 2017; 163: 417-21. DOI: https://doi.org/10.1007/s10549-017-4224-6
Zendehdel M, Niakan B, Keshtkar A, et al. Subtypes of benign breast disease as a risk factor for breast cancer: A systematic review and meta-analysis protocol. Iran journal Medical Science. 2018; 43: 1-8.
Kabat GC, Jones JG, Olson N, et al. A multi-center prospective cohort study of benign breast disease and risk of subsequent breast cancer. Cancer causes & control : CCC. 2010; 21: 821-8. http://www.ncbi.nlm.nih.gov/pubmed/20084540 15.Frazier AL and Rosenberg SM. Preadolescent and adolescent risk factors for benign breast disease. Journal of Adolescent Health. 2013; 52: 36-40. http://www.ncbi.nlm.nih.gov/pubmed/23601609 DOI: https://doi.org/10.1007/s10552-010-9508-7
Angeles-Llerenas A, Ortega-Olvera C, Perez-Rodriguez E, et al. Moderate physical activity and breast cancer risk: The effect of menopausal status. Cancer causes & control : CCC. 2010; 21: 577-86. http://www.ncbi.nlm.nih.gov/pubmed/20084545 DOI: https://doi.org/10.1007/s10552-009-9487-8
Berkey CS, Willett WC, Frazier AL, et al. Prospective study of growth and development in older girls and risk of benign breast disease in young women. Cancer. 2011; 117: 1612-20. http://www.ncbi.nlm.nih.gov/pubmed/21328325 DOI: https://doi.org/10.1002/cncr.25692
Huo D, Adebamowo CA, Ogundiran TO, et al. Parity and breastfeeding are protective against breast cancer in nigerian women. British journal of cancer. 2008; 98: 992-6. DOI: https://doi.org/10.1038/sj.bjc.6604275
Qian F, Ogundiran T, Hou N, et al. Alcohol consumption and breast cancer risk among women in three sub-saharan african countries. PLoS ONE. 2014; 9: e106908. https://http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4157846/pdf/pone.0106 908.pdf DOI: https://doi.org/10.1371/journal.pone.0106908
Baer HJ, Schnitt SJ, Connolly JL, et al. Early life factors and incidence of proliferative benign breast disease. Cancer Epidemiology Biomarkers Prevention. 2005; 14: 2889. DOI: https://doi.org/10.1158/1055-9965.EPI-05-0525
Minami Y, Ohuchi N, Taeda Y, et al. Risk factors for benign breast disease according to histopathological type: Comparisons with risk factors for breast cancer. Japan Journal of Cancer Research. 1998; 89: 116-23. DOI: https://doi.org/10.1111/j.1349-7006.1998.tb00538.x
Worsham MJ, Raju U, Lu M, et al. Risk factors for breast cancer from benign breast disease in a diverse population. Breast Cancer Research Treatment. 2009; 118: 1-7. http://www.ncbi.nlm.nih.gov/pubmed/18836828 DOI: https://doi.org/10.1007/s10549-008-0198-8
Ezeonu PO, Ajah LO, Onoh RC, et al. Evaluation of clinical breast examination and breast ultrasonography among pregnant women in abakaliki, nigeria. OncoTargets and Therapy. 2015; 2015: 1025-9. DOI: https://doi.org/10.2147/OTT.S83437
Hou N, Ogundiran T, Ojengbede O, et al. Risk factors for pregnancy-associated breast cancer: A report from the nigerian breast cancer study. Annals of Epidemiology. 2013; 23: 551-7. DOI: https://doi.org/10.1016/j.annepidem.2013.06.008
Odedina SO, Ajayi IO, Adeniji-Sofoluwe A, et al. A longitudinal study of the prevalence and characteristics of breast disorders detected by clinical breast examination during pregnancy and six months postpartum in ibadan, southwestern nigeria. BMC women's health. 2018; 18: 152. http://www.ncbi.nlm.nih.gov/pubmed/30231883 DOI: https://doi.org/10.1186/s12905-018-0647-4
Pearlman MD and Griffin JL. Benign breast disease. Obstetric Gynecology. 2010; 116: 747-58. DOI: https://doi.org/10.1097/AOG.0b013e3181ee9fc7
Hou N, Ndom P, Jombwe J, et al. An epidemiologic investigation of physical activity and breast cancer risk in africa. Cancer Epidemiology Biomarkers and Prevention. 2014; 23: 2748-56. http://www.ncbi.nlm.nih.gov/pubmed/25242052 28.Wu C, Ray RM, Lin MG, et al. A case-control study of risk factors for fibrocystic breast conditions: Shanghai nutrition and breast disease study, china, 1995-2000. DOI: https://doi.org/10.1158/1055-9965.EPI-14-0675
American journal of epidemiology. 2004; 160: 945-60. DOI: https://doi.org/10.1093/aje/kwh318
http://www.ncbi.nlm.nih.gov/pubmed/15522851
Goehring C and Morabia A. Epidemiology of benign breast disease, with special attention to histologic types. Epidemiologic Reviews. 1997; 19: 310-27. DOI: https://doi.org/10.1093/oxfordjournals.epirev.a017960
Freire de Oliveira C. Oral contraceptives and benign diseases. Fertility Control Reviews. 1995; 4: 19-22.
Coriaty Nelson Z. Risk factors for fibroadenoma in a cohort of female textile workers in shanghai, china. American journal of epidemiology. 2002; 156: 599-605. DOI: https://doi.org/10.1093/aje/kwf094
Sighoko D, Ogundiran T, Ademola A, et al. Breast cancer risk after full-term pregnancies among african women from nigeria, cameroon, and uganda. Cancer 2015; 10.1002/cncr.29305.
Silvera SA and Rohan TE. Benign proliferative epithelial disorders of the breast: A review of the epidemiologic evidence. Breast cancer research and treatment. 2008; 110: 397-409. http://www.ncbi.nlm.nih.gov/pubmed/17849184 DOI: https://doi.org/10.1007/s10549-007-9740-3
Van den Brandt PA, Spiegelman D, Yaun SS, et al. Pooled analysis of prospective cohort studies on height, weight, and breast cancer risk. American journal of epidemiology. 2000; 152: 514-27. http://www.ncbi.nlm.nih.gov/pubmed/10997541 DOI: https://doi.org/10.1093/aje/152.6.514
Copyright (c) 2022 Stella O. Odedina, IkeOluwapo O. Ajayi, Imran O. Morhason-Bello, Babatunde Adedokun, Dezheng Huo, Olufunmilayo I. Olopade, Oladosu A. Ojengbede

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.