Dojčenie a rakovina u detí

Podľa výsledkov štyroch zo šeistich štúdii majú dojčené dievčatká cca o 20-35% nižšie riziko, že u nich v dospelosti vznikne rakovina prsníka. Závery niektorých prác takisto naznačujú, že dojčenie chráni deti pred vznikom leukémie, Hodgkinovho lymfómu a iných onkologických ochorení. Mechanizmus protektívneho efektu materského mlieka zatiaľ nie je známy – uvažuje sa o pozitívnom modulačnom vplyve na imunitný systém dieťaťa, ktoré sa tak dokáže lepšie brániť pred prienikom rakovinových buniek. Takisto bola popísaná indukcia apoptózy onko-buniek určitými proteínmi nachádzajúcimi sa v materskom mlieku. Na druhej strane, teórie podľa ktorých by dojčenie mohlo byť rizikovým faktorom vzniku rakoviny u dieťaťa sa nepotvrdili. (Na základe pozorovaní u myší sa uvažovalo o možnom prenose onkogénnych vírusov z matky na dieťa). Takisto sa nezdá, že by sa v materskom mlieku výrazne koncentrovali karcinogény pritomné v životnom prostredí.
 
Cancer Causes Control 1999 Dec;10(6):561-73
 
In-utero and early life exposures in relation to risk of breast cancer. 
Potischman N, Troisi R 
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland 20892-7366, USA. nap@schoolph.umass.edu
OBJECTIVES: In response to a hypothesis by Trichopoulos that risk of adult breast cancer is related to high estrogen exposure in utero, studies have been undertaken using proxy indicators of prenatal estrogens. The epidemiologic studies addressing these early factors will be reviewed, consistency with proposed biologic mechanisms will be addressed and recommendations for future research will be presented. METHODS: All studies identified in the literature addressing these in utero and early life factors related to adult breast cancer will be included in the review. The study results will be summarized by risk factor, followed by commentary on the findings. RESULTS: Review of epidemiologic studies suggests strong risks related to having been born of a twin pregnancy and reduced risks from a preeclamptic or eclamptic pregnancy. Birthweights greater than 4,000 grams have been associated with relative risks of 1.5-1.7 for breast cancer compared with normal birthweights (2,500-2,999 grams). Having been breastfed as an infant has been associated with a 20-35% reduction in risk of premenopausal breast cancer in four of six studies evaluating this factor. Some studies suggest an influence of older maternal age, perhaps only for firstborn offspring, but the data are not consistent. Smoking during the pregnancy does not seem to impart any risk for the daughter, severe nausea for two or three trimesters may be related to increased risk, and results are inconsistent for birth length, placental weight and gestational age. CONCLUSION: Although the results from epidemiologic studies assessing prenatal exposures are consistent with the hypothesis concerning estrogen exposure, the specific biologic mechanisms remain largely unknown. Relatively few epidemiologic studies have been published addressing these novel hypotheses; more studies with innovative research methods and analytic approaches are warranted to evaluate these exposures in the distant past.
 
Int J Cancer 1999 Dec 10;83(6):712-7
Parental occupation and other factors and cancer risk in children: I. Study methodology and non-occupational factors. 
Smulevich VB, Solionova LG, Belyakova SV 
Laboratory for Prevention of Carcinogenic Exposures, Russian Academy of Medical Sciences, Moscow, Russia.
A population-based case-control study of risk factors for childhood cancer was conducted for 593 cases diagnosed over the period 1986-1988 in Moscow children 0 to 14 years of age. Two healthy controls to every case were selected from registers of local pediatric polyclinics by age, gender and residence. The parents of 593 cases and 1181 controls were interviewed face-to-face. Significantly higher odds ratios (OR) were associated with cancer in close relatives [OR 1.6; 95% confidence interval (CI) 1.3-1.9], any pathology associated with pregnancy (OR 2.9; 95% CI 2.4-3.6), including threatened miscarriage (OR 2.1; 95% CI 1.5-3.0), toxemia (OR 2.2; 95% CI 1.8-2.8) and hormone treatment during pregnancy (OR 2.2; 95% CI 1.0-4.5). Pre-term births were significantly associated with brain-cancer risk (6/1; OR 13.3; 95% CI 1.5-301.2). For low birth weight (< or = 2500 g) children born from full-term pregnancy, the OR for all cancers combined was 2.5 (23/22; 95% CI 1.4-4.7) and for leukemias 4.7 (9/4; 95% CI 1.4-16.5). In all, 100 cases and 151 controls had birth weight > or = 4000 g (OR 1.4; 95% CI 1.1-1.9). Risk of nephroblastoma was also significantly related to this factor (11/5; OR 5.1; 95% CI 1.6-16.4). A positive trend of OR with decreasing duration of breastfeeding was significant for all cancer combined (p < 0.05). Significantly higher OR were observed for dermatitis (12/6; OR 4.0; 95% CI 1.4-12.1) and viral hepatitis (40/22; OR 3.8; 95% CI 2.3-6.3) in child medical history.
 
J Natl Cancer Inst 1999 Oct 20;91(20):1765-72
Breast-feeding and risk of childhood acute leukemia. 
Shu XO, Linet MS, Steinbuch M, Wen WQ, Buckley JD, Neglia JP, Potter JD, Reaman GH, Robison LL 
Division of Pediatric Epidemiology and Clinical Research, University of Minnesota, Minneapolis, USA.
BACKGROUND: Breast-feeding is well known to have a protective effect against infection in infants. Although the long-term effects of breast-feeding on childhood cancer have not been studied extensively, a protective effect against childhood Hodgkin's disease and lymphoma has been suggested previously from small investigations. In this study, we tested the hypothesis that breast-feeding decreases the risk of childhood acute leukemia. METHODS: A total of 1744 children with acute lymphoblastic leukemia (ALL) and 1879 matched control subjects, aged 1-14 years, and 456 children with acute myeloid leukemia (AML) and 539 matched control subjects, aged 1-17 years, were included in the analysis. Information regarding breast-feeding was obtained through telephone interviews with mothers. All leukemias combined, histologic type of leukemia (ALL versus AML), immunophenotype of ALL (early pre-B cell, pre-B cell, or T cell), and morphology of AML were assessed separately in the data analysis. RESULTS: Ever having breast-fed was found to be associated with a 21% reduction in risk of childhood acute leukemias (odds ratio [OR] for all types combined = 0.79; 95% confidence interval [CI] = 0.70-0.91). A reduction in risk was seen separately for AML (OR = 0.77; 95% CI = 0.57-1.03) and ALL (OR = 0.80; 95% CI = 0.69-0.93). The inverse associations were stronger with longer duration of breast-feeding for total ALL and AML; for M0, M1, and M2 morphologic subtypes of AML; and for early pre-B-cell ALL. CONCLUSION: In this study, breast-feeding was associated with a reduced risk of childhood acute leukemia. If confirmed in additional epidemiologic studies, our findings suggest that future epidemiologic and experimental efforts should be directed at investigating the anti-infective and/or immune-stimulatory or immune-modulating effects of breast-feeding on leukemogenesis in children.
 
Int J Cancer Suppl 1998;11:29-33
Review of the evidence for an association between infant feeding and childhood cancer. 
Davis MK 
Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA. mkdl@cdc.gov
To assess the association between infant feeding and childhood cancer, a qualitative review of 9 published case-control studies was undertaken. The results of this synthesis suggest that children who are never breast-fed or are breast-fed short-term have a higher risk than those breast-fed for > or = 6 months of developing Hodgkin's disease (HD), but not non-Hodgkin's lymphoma or acute lymphoblastic leukemia. HD has features of a complex cellular immune disorder and of chronic infection. Human milk contains an extensive array of anti-microbial activity and appears to stimulate early development of the infant immune system. Artificially fed infants negotiate exposure to infectious agents without the benefits of this immunologic armament and do not do as well as breast-fed infants in resisting infection. Thus, human milk may make the breast-fed infant better able to negotiate future carcinogenic insults by modulating the interaction between infectious agents and the developing infant immune system or by directly affecting the long-term development of the infant immune system. Further research should attempt to confirm the association between infant feeding and HD in large, population-based, case-control studies. Improved measurement of infant feeding must be addressed if future studies are to advance our understanding of this association. In addition, studies of specific measures of immunity, particularly of cellular immune responses, should be conducted in populations of breast-fed and non-breast-fed young children.
 
Proc Natl Acad Sci U S A 1995 Aug 15;92(17):8064-8
Apoptosis induced by a human milk protein. 
Hakansson A, Zhivotovsky B, Orrenius S, Sabharwal H, Svanborg C 
Department of Medical Microbiology, Lund University, Sweden.
To the breast-fed infant, human milk is more than a source of nutrients; it furnishes a wide array of molecules that restrict microbes, such as antibodies, bactericidins, and inhibitors of bacterial adherence. However, it has rarely been considered that human milk may also contain substances bioactive toward host cells. While investigating the effect of human milk on bacterial adherence to a human lung cancer cell line, we were surprised to discover that the milk killed the cells. Analysis of this effect revealed that a component of milk in a particular physical state--multimeric alpha-lact-albumin--is a potent Ca(2+)-elevating and apoptosis-inducing agent with broad, yet selective, cytotoxic activity. Multimeric alpha-lactalbumin killed all transformed, embryonic, and lymphoid cells tested but spared mature epithelial elements. These findings raise the possibility that milk contributes to mucosal immunity not only by furnishing antimicrobial molecules but also by policing the function of lymphocytes and epithelium. Finally, analysis of the mechanism by which multimeric alpha-lactalbumin induces apoptosis in transformed epithelial cells could lead to the design of antitumor agents.
 
Chemosphere 1998 Oct-Nov;37(9-12):1761-72
Breast milk contamination in Kazakhstan: implications for infant feeding. 
Lutter C, Iyengar V, Barnes R, Chuvakova T, Kazbekova G, Sharmanov T 
Pan American Health Organization, Washington, DC 20037-2895, USA.
To assist the Ministry of Health of Kazakhstan in making infant feeding recommendations, breast milk samples were analyzed for PCDDs/PCDFs, PCBs, chlorinated pesticides, toxic metals, and cesium-137. Sampling sites were selected to provide a profile of representative exposures to possible contaminants; 92 breastmilk samples from 7 sites were analyzed for chlorinated contaminants and 115 samples from 8 sites were analyzed for toxic metals and cesium-137. With three important exceptions, concentrations of chlorinated contaminants and toxic metals were similar to or lower than those in Europe. Cesium-137 was not detected in any samples. The exceptions were localized contamination with the most toxic dioxin congener, 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), and generalized contamination with beta-hexachlorocyclohexane and 1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene (DDT). The localized high concentrations of TCDD (range 6.2 to 118.2 pg/g fat) are the highest documented in the world in a population currently of reproductive age. Calculated incremental lifetime excess cancer risk to an infant exposed to these high concentrations of TCDD range from 28 to 82 x 10(-5). Based in part on the results of this study, the Ministry of Health is promoting breast feeding. However, possible adverse developmental effects associated with both prenatal and postnatal (through breast milk) TCDD exposure have not been adequately assessed. Further epidemiologic research is needed to examine these effects in this newly identified high-risk population.
 
J Natl Cancer Inst 1998 Jun 17;90(12):921-4
Exposure to breast milk in infancy and adult breast cancer risk. 
Titus-Ernstoff L, Egan KM, Newcomb PA, Baron JA, Stampfer M, Greenberg ER, Cole BF, Ding J, Willett W, Trichopoulos D 
Department of Community and Family Medicine, Dartmouth Medical School, Hanover, NH 03756-0001, USA.
BACKGROUND: There is considerable interest in the possibility of an infectious etiology for human breast cancer. Although studies have shown that certain strains of mice transmit mammary tumor virus via breast milk, few epidemiologic studies have addressed this topic in humans. METHODS: We evaluated the relationship between having been breast-fed as an infant and breast cancer risk among 8299 women who participated in a population-based, case-control study of breast cancer in women aged 50 years or more. Case women were identified through cancer registries in three states (Massachusetts, New Hampshire, and Wisconsin); control women were identified through statewide driver's license lists (age <65 years) or Medicare lists (ages 65-79 years). Information on epidemiologic risk factors was obtained through telephone interview. We used multiple logistic regression to assess having been breast-fed and maternal history of breast cancer in relation to breast cancer occurrence both in premenopausal women (205 case women; 220 control women) and in postmenopausal women (3803 case women; 4071 control women). RESULTS: We found no evidence that having been breast-fed increased breast cancer risk in either premenopausal women (odds ratio [OR] = 0.65; 95% confidence interval [CI] = 0.41-1.04) or postmenopausal women (OR = 0.95; 95% CI = 0.85-1.07). In addition, breast cancer risk was not increased by having been breast-fed by a mother who later developed breast cancer. CONCLUSION: Our results do not support the hypothesis that a transmissible agent in breast milk increases breast cancer risk. Because premenopausal women were not well represented in our study population, our findings with regard to this group may not be generalizable and should be viewed with caution.
 
Am Ind Hyg Assoc J 1997 Jun;58(6):425-31
Lactational transfer of volatile chemicals in breast milk. 
Fisher J, Mahle D, Bankston L, Greene R, Gearhart J 
Armstrong Laboratory, Toxicology Division, Wright-Patterson AFB, Ohio 45433, USA.
Lactational transfer of chemicals to nursing infants is a concern for occupational physicians when women who are breast-feeding return to the workplace. Some work environments, such as paint shops, have atmospheric contamination from volatile organic chemicals (VOCs). Very little is known about the extent of exposure a nursing infant may receive from the mother's occupational exposure. A physiologically based pharmacokinetic model was developed for a lactating woman to estimate the amount of chemical that a nursing infant ingests for a given nursing schedule and maternal occupational exposure. Human blood/air and milk/air partition coefficients (PCs) were determined for 19 VOCs. Milk/blood PC values were above 3 for carbon tetrachloride, methylchloroform, perchloroethylene, and 1,4-dioxane, while the remaining 16 chemicals had milk/blood PC values of less than 3. Other model parameters, such as solid tissue PC values, metabolic rate constants, blood flow rates, and tissue volumes were taken from the literature and incorporated into the lactation model. In a simulated exposure of a lactating woman to a threshold limit value concentration of an individual chemical, only perchloroethylene, bromochloroethane, and 1,4-dioxane exceeded the U.S. Environmental Protection Agency non-cancer drinking water ingestion rates for children. Very little data exists on the pharmacokinetics of lactational transfer of volatile organics. More data are needed before the significance of the nursing exposure pathway can be adequately ascertained. Physiologically based pharmacokinetic models can play an important role in assessing lactational transfer of chemicals.
 
Br J Cancer 1993 Apr;67(4):842-5
Breast-feeding and breast cancer in the offspring. 
Ekbom A, Hsieh CC, Trichopoulos D, Yen YY, Petridou E, Adami HO 
Cancer Epidemiology Unit, Uppsala University Hospital, Sweden.
The causation of breast cancer in certain strains of mice by a virus that can be transmitted vertically, through the milk produced during lactation, has led to the hypothesis that a similar phenomenon could exist in humans. There have been laboratory-based studies in humans suggesting that a virus may be involved in the etiology of female breast cancer although other investigations did not support this hypothesis. Descriptive data and epidemiologic evidence of ecologic nature do not indicate a role of lactation in the causation of human breast cancer, but the hypothesis has not been adequately assessed in analytic epidemiologic studies. A nested case-control study undertaken in Sweden to examine the role of prenatal factors on breast cancer risk in the offspring, allowed the evaluation of the importance of breast-feeding in the causation of this disease. Standardised records concerning women born at the Uppsala University Hospital from 1874 to 1954 were linked with invasive breast cancer incident cases, identified through their unique national registration number in the Swedish Cancer Registry during 1958-1990. For each case with breast cancer, the females born to the first three mothers admitted after the case's mother were selected as potential matching controls. Only controls living in Sweden and free from breast cancer until the time of diagnosis of breast cancer in the corresponding case were eventually included in the study. The analysis was based on 458 cases of breast cancer born in singleton pregnancies and 1,197 singleton age- and birth date-matched controls. Breast-feeding was not a significant or suggestive risk factor for breast cancer in the offspring; compared to women who at discharge were wholly or partly breastfed, women who as newborn were not breastfed had a relative risk of breast cancer of 0.97 with 95% confidence interval 0.44-2.17 (P = 0.95).
 
Int J Epidemiol 1995 Feb;24(1):27-32
Infant breastfeeding and the risk of childhood lymphoma and leukaemia. 
Shu XO, Clemens J, Zheng W, Ying DM, Ji BT, Jin F 
Department of Epidemiology, Shanghai Cancer Institute, People's Republic of China.
BACKGROUND. A protective effect of breastfeeding on childhood lymphoma has been indicated but supportive evidence is limited. METHOD. Data from a population-based case-control study of childhood cancer in Shanghai, including 82 lymphoma cases and 159 acute leukaemia cases and their age- and sex-matched community controls, were analysed. RESULTS. After adjustment for potentially confounding variables, a slight, although non-significant, reduction in risk of lymphoma was observed among children who were breastfed as infants versus those who were not (odds ratio [OR] = 0.69; 95% CI: 0.3-1.7). The reduction was somewhat greater for children who had been breastfed longer and appeared to pertain primarily to Hodgkin's disease and to cases diagnosed before the age of 6 years. As expected, there was no reduction in risk of acute leukaemia associated with breastfeeding. CONCLUSIONS. Although providing neither strong support for nor refuting the study hypothesis, these data suggest that if breastfeeding does reduce the risk of lymphoma, its protective effect among Chinese children is likely modest in magnitude and concentrated in certain subgroups defined by length of breastfeeding, age at diagnosis and histological subtype of cancer.
 
Am J Public Health 1994 Sep;84(9):1458-62
 
Is breast-feeding in infancy associated with adult longevity? 
Wingard DL, Criqui MH, Edelstein SL, Tucker J, Tomlinson-Keasey C, Schwartz JE, Friedman HS 
Department of Family and Preventive Medicine, University of California, San Diego, La Jolla 92093-0607.
OBJECTIVES. The purpose of the study was to determine whether breast-feeding is associated with increased longevity or cause-specific survival. METHODS. Teachers throughout California identified intellectually gifted children as part of a prospective study begun in the 1920s by Lewis Terman. Information on breast-feeding was available on 1170 subjects, who have been followed for more than 65 years. RESULTS. Survival analysis (Cox proportional hazards model) indicated that breast-feeding was associated with increased longevity, even after adjustment for age at baseline, birthweight, infant health, and childhood socioeconomic status, but only among men, and the association was not significant (P = .15). Neither cardiovascular disease nor cancer survival was significantly associated with duration of breast-feeding for either sex. Survival from deaths due to injuries was positively associated with breast-feeding after adjustment (P = .03) and demonstrated a clear gradient with duration, but only among men. CONCLUSIONS. Overall, the present study does not provide strong evidence that breast-feeding is associated with adult longevity. The reduced risk of death from injury may reflect chance, in that the association was significant only for men, or it may reflect psychosocial correlates of breast-feeding practices.
 
Indian Pediatr 1993 May;30(5):651-7
Breastfeeding and childhood cancer. 
Mathur GP, Gupta N, Mathur S, Gupta V, Pradhan S, Dwivedi JN, Tripathi BN, Kushwaha KP, Sathy N, Modi UJ, et al 
Department of Pediatrics, Medical College, Kanpur.
Total duration of breastfeeding and of exclusive breastfeeding was studied and compared in 99 childhood cancer cases and 90 controls. The difference between the average duration of breastfeeding in cases and controls was significant (p < 0.05), but when average duration of exclusive breastfeeding was compared in cases and controls the difference was highly significant (p < 0.001). In lymphoma cases and controls the difference between the average duration of breastfeeding was moderately significant (p < 0.01). However, when average duration of exclusive breastfeeding was compared in lymphoma cases and controls the difference was highly significant (p < 0.001). When other cancer groups and controls were compared with respect to their total duration of breastfeeding and duration of exclusive breastfeeding the differences when insignificant (p > 0.05). Cases and controls were not different with respect to their age, sex, birth year, birth order, age and educational status of mothers, smoking of fathers and socioeconomic status. However, a positive family history of cancer was obtained in 4 (4%) of cases whereas in controls it was obtained in only 1 (1.1%).
 
East Afr Med J 1999 Jan;76(1):3-9
Cancers in children younger than age 16 years in Kenya. 
Mwanda OW 
Department of Haematology and Blood Transfusion, College of Health Sciences, University of Nairobi, Kenya.
OBJECTIVE: To determine the number of cancers seen in six months in children aged below sixteen years and to look for any associations with breastfeeding, parental ages, smoking, water availability and consanguinity. DESIGN: Prospective case study from June 1997 through December 1997. SETTING: Seven provincial hospitals and Kenyatta National Referral Hospital. SUBJECTS: Both sexes with tissue proven malignancy. INTERVENTIONS: By obtaining clinical information, and laboratory evaluatory results. MAIN OUTCOME MEASURES: Proportions of vital statistics, anatomic site, stage and histology of cancer, vaccination, breastfeeding, congenital abnormality, parental vital statistics, education, smoking, water availability status and consanguinity. RESULTS: One hundred and fifty seven cases were evaluated. Male to female (M:F) ratio was 1.5:1. Mean ages: patients 6.5, fathers 36.6, mothers 31.1 years. Histologic types were: Burkitt's lymphoma (BL) 45%, nephroblastoma 14%, Hodgkin's lymphoma 9.5%, acute lymphocytic leukaemia 7.6%, retinoblastoma 5.7%, acute myeloid leukaemia 5.1%. The age distribution was as follows: 0-5 years, 46.5%, 6-10, 39.5% and 11-16 years 14%. The birth places of the children were as follows: Nyanza 25%, Central 21%, Eastern 16%, Western 13%, Rift Valley 9%, Coast 8%, Nairobi 8% and North Eastern had less than one per cent. The ethnic distribution was; Luo 25%, Kikuyu 22%, Luhya 13%, Kamba 10%, Coastal 6%, Kalenjin 6%, others 19%. Fifty per cent of the cases studied were breastfed for over six months, 34% for 3-6 months, five per cent less than three months and eleven per cent were not breastfed. Eighty five per cent of the cases received complete vaccination. The modal number of siblings was four and only 49% of parents received formal education. No consanguinity was noted in the studied population. The abdomen and jaw were main anatomic sites involved by the tumours. CONCLUSION: This study showed that the commonest childhood tumour is Burkitt's lymphoma and nephroblastoma is the commonest solid tumour. While the results demonstrate geographic and ethnic variations, other factors studied do not appear to influence the characteristics of cancers in the cases investigated.
 
Br J Cancer 1999 May;80(3-4):585-90
Association of childhood leukaemia with factors related to the immune system. 
Schuz J, Kaletsch U, Meinert R, Kaatsch P, Michaelis J 
Institut fur Medizinische Statistik und Dokumentation der Johannes Gutenberg-Universitat Mainz, Germany.
The childhood peak of common acute lymphoblastic leukaemia has been proposed as being a rare response to delayed exposure to a common infection. In this context, factors related to the child's immune system are of special interest. Information on such factors was obtained in a recent German case-control study comprising more than 1000 children with acute leukaemia. Neither being the first-born child, nor a short duration of breastfeeding, indicators of a deficit in viral contacts during infancy or the number of infectious diseases, were significant risk factors. We observed a strong association with fewer routine immunizations with a 3.2-fold increase for those children getting less than four immunizations, but this association could partly be explained by reporting bias. While tonsillectomy or appendectomy increased the risk of leukaemia in our studies, a protective effect of allergies could be seen. In summary, we found only weak support for the delayed exposure hypothesis. To some extent this may be due to the chosen surrogate markers which reflect, rather indirectly, immunological isolation in infancy and delayed exposure to common viruses. However, the significant findings for routine immunizations, tonsillectomy and allergies of the child or its parents merit further investigation.
 
Early Hum Dev 1997 Oct 29;49 Suppl:S131-42
Does breast feeding have any impact on non-infectious, non-allergic disorders? 
Golding J, Emmett PM, Rogers IS 
Unit of Pediatric and Perinatal Epidemiology, University of Bristol, UK.

Feeding of breast milk in the first weeks of life appears to have a strong protective effect against necrotising enterocolitis. Nevertheless breast milk also seems to be positively linked to the development of jaundice and to late haemorrhagic disease in infants who have not received vitamin K supplements. There is no consistent evidence that other childhood conditions such as insulin dependent diabetes or cancer are less prevalent among children who have been breast fed. Among adult conditions suggested to be less prevalent in the breast fed, only single reports of significant findings for multiple sclerosis and breast cancer exist and convincing corroboration is not available. There are a number of studies that indicate a relationship between breast feeding and later cholesterol levels--and one that has considered the mortality of ischaemic heart disease among adult males. There is some suggestion that breast feeding (during the first year of life) is the optimal protection against future raised lipid levels and mortality from coronary heart disease, but the evidence is far from conclusive. The major health advantage of breast feeding that has been clearly demonstrated remains in the protection of the infant from certain infections in early life. If there are other long-term health advantages they have yet to be fully elucidated and confirmed.