Breastfeeding and Public Health
Shortened or absent breastfeeding has enormous public health implications for all segments of society: children and adults, male and female. Below are some statistics:
- Women who have never breastfed have 1.2-2.8 times the risk of pre-menopausal
breast cancer.1 Breast cancer alone kills about 1,600 Massachusetts
residents per year, striking about 4,400 people per year.2
About one-quarter of breast cancer deaths are in pre-menopausal women.3
(HIV, by comparison, killed 327 people in 2001).4
- Two years of lifetime breastfeeding can dramatically lower the risk of pre-menopausal breast cancer. If a woman has two children, and breastfeeds each for a year (the recommended guideline), her risk of pre-menopausal breast cancer is lowered by 28-61%.1 Breastfeeding can lower the risk of any type of breast cancer by 4.3% for every 12 months of breastfeeding.5
- Women who have never breastfed have 1.25 times the rate of ovarian cancer,1,6 higher rates of endometrial cancer,6,7 as well as osteoporosis and hip fractures.1,8,9 Ovarian cancer kills about 400 people per year in this state.2
- Infants who were not breastfed have 7 times as much necrotizing enterocolitis (which has a 30% mortality rate);10 twice as many cases of otitis media, higher rates of hospitalization, higher rates of lower respiratory tract illness, gastrointestinal illness, meningitis; 15-18 Sudden Infant Death Syndrome (SIDS)14,19-20; and abandonment by their mothers.21
- Children who were not breastfed have higher rates of type 1 diabetes mellitus,11,14,22-24 leukemia and lymphoma,11,14,25 dental caries,26 dental malocclusion.27-28
- Children and adults who were not breastfed as babies have higher rates of Crohn's disease and ulcerative colitis,11,14,29 and celiac disease.30
- Massachusetts spends about $27 million/year to treat excessive cases of infant diarrhea, respiratory syncitial virus, and otitis media in formula fed infants.31
- It is estimated that an average of $331-475 in extra health care costs are incurred per child in the first year of life to treat excessive cases of lower respiratory tract infection, gastrointestinal disease, and otitis media in formula fed infants, compared to infants breastfed for as little as three months.32
- Nursing mothers miss less work because their children are healthier.33
- Maternal pre-menopausal breast cancer rates1 and rates of childhood otitis media,17,18 leukemia,25 and type 1 diabetes mellitus 22,23 all go down more with increasing duration of breastfeeding.
- Although the links between breastfeeding and asthma have been controversial, there remains considerable evidence that children who were not exclusively breastfed have 1.4-2.4 times the odds of having asthma.34-37 The prevalence of asthma is 10-30% among children and adolescents.39-43
Further, many children with asthma go on to have adult asthma as well.
Melissa Bartick, MD, MS
- Labbok MH. Effects of breastfeeding on the mother. Pediatric Clinics of North America 2001 Feb;48(1) 143-58.
- Massachusetts Department of Public Health. Cancer Incidence and Mortality, 1994-1998.
Boston, 2000. Online at http://http://www.mass.gov/dph.
Raw incidences of breast cancer and ovarian cancer totals, over the 5 year periodbetween 1994-98 are 24,
232 and 2,847, respectively. All stated rates are annually adjusted to the 1970 US population.
Per the US Census Bureau, the US population in 1970 was 203,302,031 and the state population was 5,689,
170. Breast cancer mortality figures may be based on 1990 census data (population 6,016,425) which
means 1,570 breast cancer deaths/year. Per 2000 census, US population is 281,421,906 and state
population is 6,349,097.
- .Imaginis website. Breast cancer: statistics on incidence, survival, and screening. http://www.imaginis.com/breasthealth/statistics.asp?mode=1.
- Massachusetss Department of Public Health, HIV/AIDS Surveillance Program,
In 1997 there were 375 deaths; in 1999 there were 220 deaths, according to this
website. The Boston Globe reported 327 AIDS deaths in 2001 in
"AIDS/HIV rate rising in state" by Anand Vaishnav, December 2, 2002.
- Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50,302 women with breast cancer and 96,973 women without the disease. Lancet 2002 Jul 20; 360:187-195.
- Salazar-Martinez E, et al. Reproductive factors of ovarian and endometrial cancer risk in a high fertility population in Mexico. Cancer Res 1999Aug1;59(5):3658-62.
- Newcomb PA, Trentham-Dietz A. Breast feeding practices in relation to endometrial cancer risk, USA. Cancer Causes Control 2000 Aug;11(7):663-7.
- Kreiger N, Kelsey, J, et al. An epidemiologic study of hip fractures in postmenapausal women. 1982; Am J Epidemiology 116:141-48.
- Cumming RG, Klineberg RJ. Breastfeeding and other reproductive factors and the risk of hip fractures in elderly women. Int J Epidemiol 1993; 22:684-91.
- Lucas A, Cole T. Breastmilk and neonatal necrotizing enterocolitis. Lancet 1990;336:1519-23.
- American Academy of Pediatrics Work Group on Breastfeeding. Breastfeeding and the use of human milk. 1997 Dec; Pediatrics, 100(6). (view document online at http://aap.org/policy/re9729.html )
- Kovar MG, Serdul MK, Marks JS, et al. Review of the epidemiologic evidence for an association between infant feeding and infant health. Pediatrics. 1984;74:S615-S638.
- Beaudry M, Dufour R, Carcoux S. Relation between infant feeding and infections during the first six months of life. J Pediatr 1995;126:191-97.
- Walker, M. A fresh look at the risks of artificial infant feeding. 1993; J Hum Lact 9(2):91-107.
- Hening, MJ. Host defense benefits of breastfeeding for the infant: effect of breastfeeding duration and exclusivity. Pediatric Clinics of North America 2001 Feb; 48(1):105-123.
- Klein JO. The burden of otitis media. Vaccine 2001; 19: S2-S8.
- Paradise JL, Rockette HE, et al. Otitis media in 2253 Pittsburgh-area infants: prevalence and risk factors during the first two years of life. Pediatrics 1997;99(3):318-33.
- Alho OP, Koivu M et al. Risk factors for recurrent acute otitis media and respiratory infection in infancy. Int J Pediatr Ototrhinolaryngol 1990;19(2):151-61.
- Ford RPK, Taylor BJ, Mitchell EA, et al. Breastfeeding and the risk of sudden infant death syndrome. Int J Epidemiol 1993;22:885-90.
- Mitchell EA, Scragg R, et al. Cot death supplement: results from the first year of the New Zealand cot death study. NZ Med J 1991; 104:71-76.
- Lvoff NM et al. Effect of the Baby Friendly Initiative on infant abandonment in a Russian hospital. Arch Ped Adolesc Med 2000; 154(5):474-77.
- Mayer EJ, Hamman RF, Gay EC et al. Reduced risk of IDDM among breast-fed children. The Colorado IDDM Registry. Diabetes 1998;37:1625-32.
- Virtanen SM, Rasanen L, Aro A et al. Infant feeding in Finnish children <7 year of age with newly diagnosed IDDM. Diabetes Care 1991;14:45-17.
- Gerstein HC. Cow's milk exposure and type 1 diabetes mellitus. Diabetes Care 1994;17:13-19.
- Shu XO, Linet MS, et al. Breastfeeding and risk of childhood acute leukemia. J Natl Cancer Inst 1999; 91(20);1765-72.
- Mattos-Graner RO, Zelante I, Line RC, et al. The association between caries prevalence and clinical, microbiological, and dietary variables in 1.0-2.5 year old Brazilian children. Caries Res 1998;32(5):319-23.
- Labbok M, Hendershot G. Does breastfeeding protect against malocclusion? Analysis of the 1981 child health supplement to the national health interview survey. 1987; Am J Rev Med 3:227-232.
- Karjalainen S, Ronning O, Lapileimu H, Simell O. Association between early weaning, non-nutritive sucking habits and occlusal anomalies in 3-year-old Finnish children. Int J Paediatr Dent 1999 Sep; 9(3):169-73.
- Rigas A, Rigas B, et al. Breast-feeding and maternal smoking in the etiology of Crohn's disease and ulcerative colitis in childhood. Ann Epidemiol 1993:3:387-92.
- Greco l, Auricchio S, Mayer M, et al. Case control study on nutritional risk factors in celiac disease. J Pediatr Gastroenterol Nutr 1988;7:395-99.
- Riordan JM. The cost of not breastfeeding: a commentary. J Hum Lact 1997; 13(2):93-97. Massachusetts figures were derived from national figures using population data.
- Ball TM, Wright AL. Health care costs of formula-feeding in the first year of life. Pediatrics 1999; (103)4:870-66.
- Cohen R, Mrtek MB, Mrtek RG. Comparison of maternal and infant illness rates among breast-feeding and formula-feeding women in two corporations. Am J Health Promot 1995; 10(2):148-53.
- Gdalevich M, Mimouni D, Mimouni M. Breastfeeding and the risk of bronchial asthma in childhood: a systematic review with meta-analysis of prospective studies. J Pediatr 2001 Aug; 139(2):261-6.
- Oddy WH, Peat JK, de Klerk NH. Maternal asthma, infant feeding, and the risk of asthma in childhood. J Allergy Clin Immunol 2002 Jul;110(1):65-7.
- Oddy WH, Holt PG,et al. Association between breastfeeding and asthma in 6 year ol d children: findings of a prospective birth cohort study. BMJ 1999 Sep 25: 319(7213):815-9.
- Chandra, RK. Five-year follow-up of high-risk infants with family history of allergy who were exclusively breast-fed or fed partial whey hydrolysate, soy, and conventional cow's milk formulas. J Pediatr Gastroenterol Nurtr 1997 Apr; 24(4):442-6.
- Wafula EM, Limbe MS et al. Effects of passive smoking and breastfeeding on childhood bronchial asthma. East Afr Med J 1999 Nov;76(11):606-9.
- Fagan JK, Scheff PA, et al. Prevalence of asthma and other allergic diseases in an adolescent population: association with gender and race. Ann Allergy Asthma Immunol 2001 Fef;86(2) 145-6.
- Hu FP, Persky V, et al. Prevalence of asthma and wheezing in public school children: association with maternal smoking during pregnancy. Ann Allergy Asthma Immunol 1997 Jul;79(1):80-4.
- Crain EF, Weiss KB, et al. An estimate of the prevalence of asthma and wheezing among inner city children. Pediatrics 1994 Sept; 94(3):356-62.
- Yeatts K, Shy C et al. Statewide adolescent asthma surveillance. J Asthma 2000 Aug;37(5):425-34.
- Yeatts KB, Shy CM. Prevalence and consequences of asthma and wheezing in African American and white adolsescents. J Adolesc Health 2001 Nov;29(5):314-19.