Metergoline in the inhibition of puerperal lactation.

Seventy-eight mothers who did not want to breast-feed their newborn infants took part in a trial to assess whether metergoline could effectively suppress puerperal lactation. Metergoline 8 mg/day was given to 69 women within 24 hours after delivery and continued for five days to prevent lactation. The remaining nine women were given a course of metergoline once lactation had started. The drug was effective in both preventing and suppressing lactation. Milk secretion, engorgement, and pain were significantly reduced in women taking metergoline. Metergoline has a similar effect to bromocriptine in suppressing lactation, but its mechanism of action remains unknown.     

Single dose cabergoline versus bromocriptine in inhibition of puerperal lactation: randomised,double blind,multicentre study. European Multicentre Study Group for Cabergoline in Lactation Inhibition.

OBJECTIVE--To compare the efficacy and safety of a single dose of 1 mg of cabergoline with that of bromocriptine 2.5 mg twice daily for 14 days in the inhibition of puerperal lactation. DESIGN--Prospective, randomised, double blind, parallel group, multicentre study. SETTING--University of hospital departments of obstetrics and gynaecology in different European countries. SUBJECTS--272 puerperal women not wishing to lactate (136 randomised to each drug). INTERVENTIONS--Women randomised to cabergoline received two 0.5 mg tablets of cabergoline and one placebo tablet within 27 hours after delivery and then placebo twice daily for 14 days. Those randomised to bromocriptine received 2.5 mg of bromocriptine and two placebo tablets within 27 hours and then 2.5 mg of bromocriptine twice daily for 14 days. MAIN OUTCOME MEASURES--Success of treatment (complete or partial) according to milk secretion, breast engorgement, and breast pain; rebound symptomatology; serum prolactin concentrations; and number of adverse events. RESULTS--Complete success was achieved in 106 of 136 women randomised to cabergoline and in 94 of 136 randomised to bromocriptine and partial success in 21 and 33 women respectively. Rebound breast symptomatology occurred respectively in five and 23 women with complete success up to day 15 (p less than 0.0001). Serum prolactin concentrations dropped considerably with both drugs from day 2 to day 15; a prolactin secretion rebound effect was observed in women treated with bromocriptine. cabergoline and 36 receiving bromocriptine (p = 0.054), occurring most during the first treatment day. CONCLUSION--A single 1 mg dose of cabergoline is at least as effective as bromocriptine 2.5 mg twice daily for 14 days in preventing puerperal lactation. Because of the considerably lower rate of rebound breast activity and adverse events and the simpler administration schedule cabergoline should be the drug of choice for lactation inhibition.     

Oxytocin enhances onset of lactation among mothers delivering prematurely.

In a double-blind group sequential trial the efficiency of an oxytocin nasal spray in enhancing lactation was studied during the first five days after delivery in women who had given birth prematurely. The cumulative volume of breast milk obtained between the second and fifth days after delivery was 3.5 times greater in primiparas given oxytocin than in primiparas given placebo. There was no significant difference in the composition of the milk between the untreated women and those given oxytocin. The results of this study show that oxytocin nasal spray is an effective and safe means of enhancing lactation in women using a breast pump.     

Zinc and copper in human milk

Studies of zinc and copper contents of breast milk were performed in 34 mothers during their lactation period until 5 days postpartum. They experienced no problems during pregnancy and delivery. All women had full term healthy infants, 22 were multiparous and 12 primiparous. The highest zinc concentration was found in the colostrum, and subsequently the concentration declined. Copper content was stable during the 5 days of lactation. Significantly lower zinc concentration and higher copper concentration were found in the serum of lactating women 3 days post partum, when compared with non-lactating women. Factors including lactation history, age of lactating women, serum levels of zinc and copper did not affect the contents of these trace minerals in breast milk.     

Influence of individual predisposition, maternal experience and lactation environment on the responses of pigs to weaning at two different ages

This study assessed the effect of predisposition to perform harmful social behaviour, maternal rearing environment, and lactation environment on the responses of pigs to weaning at 3 or 5 weeks of age. Predisposed and non-predisposed gilts were selected as dams for this study at 7 weeks of age. Selection was based on behaviour in a “tail chew” test and performance of harmful social behaviour towards penmates. The gilts were mated at puberty with boars of a similar predisposition, and farrowed at approximately 44 weeks of age. Half of the gilts of each predisposition were reared from the time of selection until farrowing in barren environments, and half in enriched environments. During lactation, gilts and litters were either housed in a similar environment to that which gilts had experienced during rearing, or in a different environment (i.e. in terms of being barren or enriched). Litters from each treatment group were weaned at either 3 weeks of age (early weaning), or 5 weeks of age. After weaning, piglets were regrouped and housed in slatted pens without access to substrates. Non-predisposition to perform harmful social behaviour was associated with reduced growth during the post-weaning period (P < 0.01), and increased belly nosing behaviour in response to early weaning (P < 0.05). These effects were not mitigated by maternal experience or lactation environment factors, and it is concluded that this type of selection may not be commercially viable. Rearing dams in barren rather than enriched environments led to reduced welfare in offspring. This was reflected in increased adrenocortical reactivity during the lactation period (P < 0.01), and increased belly nosing behaviour in response to early weaning (P < 0.05). The effect of barren maternal rearing environments on belly nosing behaviour by offspring was eliminated when pigs were housed in enriched lactation environments (P < 0.01). Enrichment during the lactation period also led to improved growth rates in the post-weaning period (P < 0.01). It is suggested that this effect was due to an enhanced ability to cope with the weaning process. Overall, the results show that both genetic and early environmental factors are important determinants of the responses of pigs to weaning. Adverse effects of barren maternal rearing environments may be overcome by housing pigs in enriched lactation environments.     

Luteinizing hormone,total estrogens and progesterone secretion during lactation and after weaning in sows

Two experiments were conducted to determine changes in serum concentrations of LH, total free estrogens and progesterone before and after weaning in sows. Blood was collected either via indwelling anterior vena cava cannula or by venipuncture and serum hormones were measured by radioimmunoassay. In Exp. I, blood was collected at 15-min intervals for 4 hr on day 7 and day 21 postpartum from three sows on each day. In addition, individual samples were collected from 10 sows on days 4 and 14 postpartum and from 11 sows on days 1, 3 and 5 after weaning (day 23 postpartum). Serum LH ranged from .2 to .8 ng/ml during lactation and averaged 1.1 ± .7, 1.1 ± .7 and 2.7 ± .7 on days 1, 3 and 5 after weaning, respectively. Progesterone was low (< 1 ng/ml) during lactation and averaged 1.9 ± .3, .6 ± .3 and 1.2 ± .3 on days 1, 3 and 5 after weaning. Estrogens were variable during lactation, averaged 121 ± 36 pg/ml on day 1 after weaning and decreased thereafter. Estrus began on day 3 after weaning in 1 sow and on day 5 in the remaining 10 sows.In Exp. II, blood was collected from seven sows at 12 to 24 hr intervals from 2 days before until 5 days after weaning (day 26 postpartum). Mean serum LH was .7 ± .1 ng/ml during 48 hr before weaning and remained unchanged after weaning until day 3 when LH increased to 6.1 ± .8 ng/ml. Serum LH concentrations then declined to 1.3 ± .8 and .9 ± .8 ng/ml on days 4 and 5 after weaning. Total estrogens averaged 31 ± 4 pg/ml during 48 hr prior to weaning and 32 ± 4, 43 ± 17, 28 ± 1, 30 ± 2, 16 ± 2 and 18 ± 2 on days 0 to 5 after weaning. Progesterone increased from 1.0 ± .3 ng/ml 24 hr before weaning to 3.0 ± .3 at weaning and then remained low (< 1 ng/ml) until after ovulation when progesterone increased. Estrus began on day 4 after weaning in all seven sows.Results from these two experiments indicate that in sows: (1) LH is suppressed during early lactation (day 7), gradually increases during late lactation (day 21) and then reaches peak concentrations after weaning near the onset of estrus, (2) estrogens increase between weaning and estrus and decline thereafter, and (3) progesterone rises transiently at weaning and then increases after estrus and ovulation.     

Suppression of Puerperal Lactation with an Ergot Alkaloid: A Double-blind Study

A double-blind trial was performed in 60 women to establish the effectiveness of an ergot alkaloid, 2-Br-alpha-ergocryptine (ergocryptine; CB 154), in suppressing puerperal lactation and to compare it with stilboestrol and a placebo. At the doses selected ergocryptine and stilboestrol were equally effective.     

Developmental and Lactational Exposure to Dieldrin Alters Mammary Tumorigenesis in Her2/neu Transgenic Mice

Breast cancer is the most common cancer in Western women and while its precise etiology is unknown, environmental factors are thought to play a role. The organochlorine pesticide dieldrin is a persistent environmental toxicant thought to increase the risk of breast cancer and reduce survival in the human population. The objective of this study was to define the effect of developmental exposure to environmentally relevant concentrations of dieldrin, on mammary tumor development in the offspring. Sexually mature FVB-MMTV/neu female mice were treated with vehicle (corn oil), or dieldrin (0.45, 2.25, and 4.5 µg/g body weight) daily by gavage for 5 days prior to mating and then once weekly throughout gestation and lactation until weaning. Dieldrin concentrations were selected to produce serum levels representative of human background body burdens, occupational exposure, and overt toxicity. Treatment had no effect on litter size, birth weight or the number of pups surviving to weaning. The highest dose of dieldrin significantly increased the total tumor burden and the volume and number of tumors found in the thoracic mammary glands. Increased mRNA and protein expression of the neurotrophin BDNF and its receptor TrkB was increased in tumors from the offspring of dieldrin treated dams. This study indicates that developmental exposure to the environmental contaminant dieldrin causes increased tumor burden in genetically predisposed mice. Dieldrin exposure also altered the expression of BNDF and TrkB, novel modulators of cancer pathogenesis.     

Ovulation frequency among sows group-housed during late lactation

Ovulation frequency during late lactation was determined among 114 sows from four commercial farms that group-housed the sows from about 3 weeks of lactation until weaning (G-farms), and among 21 sows from one farm that kept the sows individually penned throughout lactation (C-farm). Ovulation frequency was determined by applying a progesterone assay on faecal samples collected at weekly intervals from time of grouping until 3 weeks after weaning. The groups consisted of 11–22 sows and boar contact was not allowed during the 5–6 week lactation period. G-farm sows were fed ad libitum while C-farm sows were provided with a restricted food ration. During the group-housing period, 28% of the G-farm sows ovulated, whereas none of the singly housed sows ovulated during the corresponding period (P = 0.005). Ovulation frequency varied considerably between sow groups (0–54%) (P = 0.004), owing partly to differences in age. Not a single primiparous sow ovulated, whereas ovulation frequency among second to fourth parity sows and older sows (fifth parity and over) was 6% and 48%, respectively (P < 0.001). At the time of grouping and weaning, neither backfat thickness nor litter size differed between the sows that ovulated and those that were anoestrous. Preweaning mammary gland atrophy, indicating that milk production had ceased, was noted in 16% of the G-farm sows that ovulated but in only one (1%) of the anoestrus sows. Only 65% of the sows showing lactational ovulation were mated within 10 days after weaning. By contrast, 87% of the G-farms sows that were anoestrus during lactation and 100% of the C-farm sows were mated within this period.     

Effect of the Japanese diet during pregnancy and lactation or post-weaning on the risk of metabolic syndrome in offspring

We examined the effects on offspring of ingestion of the 1975 Japanese diet during pregnancy and lactation and after weaning in mice. Pregnant dams were divided into groups that were fed the Japanese diet or a control diet and raised until offspring were weaned. The offspring after weaning were further divided into groups that were raised on the Japanese diet or the control diet. Ingestion of the Japanese diet after weaning suppressed accumulation of visceral fat in offspring, and reduced the amount of lipids in serum and liver. This effect was weakened if the Japanese diet was only ingested during pregnancy and lactation. Therefore, it was suggested that ingestion of the Japanese diet of mothers during pregnancy and lactation weakens the lipid accumulation inhibitory effect of the Japanese diet in children.     

Correlation between LH response to challenges with GNRH and naloxone during lactation, and LH secretion and follicular development after weaning in the sows.

The aim of this study was of establishing a correlation between endogenous LH secretion and the magnitude of the LH response to challenges with GnRH and the opioid antagonist naloxone during lactation, and between these characteristics and LH secretion and follicular development after weaning. Sows (n = 9) were sampled for 6 h at day 2 post-partum, for 12 h on day 26 of lactation and for 6 h immediately after weaning at day 27 of lactation. Four hours after the beginning of sampling at day 26 of lactation all sows were injected with 2 mg/kg i.v. of naloxone hydrochloride and 5 h later with 100 microg/sow of GnRH. Follicular development was studied in all sows at slaughter the day after weaning. There was an effect of time (sampling period; P < 0.001) on mean plasma LH, with an increase (P < 0.05) in LH the day after weaning compared to mean LH concentrations during lactation. Naloxone and GnRH treatment both increased (P < 0.05) mean LH concentrations. A positive relationship (r = 0.58, P < 0.01) between mean plasma LH after GnRH and after weaning was established. Although there were differences (P < 0.001) between sows in follicular fluid volume, there were no correlations between mean follicular fluid volume and mean LH concentrations after GnRH or after weaning. These data indicate that the LH response to GnRH during late lactation could be useful predictor of LH activity after weaning. However, none of the measures of endogenous or induced LH secretion were associated with differences in ovarian follicular size after weaning. Direct evidence is therefore still needed for a functional link between differences in LH in lactation and differences in fertility after weaning.     

Relationship of vaginal impedance with speed of return to oestrus after weaning, oestrous behaviour, parity and lactation length in cyclic sows

The effect of weaning to oestrus interval, oestrus duration, parity, lactation length, breed and their interactions on changes of vaginal impedance in sows after weaning and during oestrus was examined. The impedance measurements were carried out by a four-electrode method. The interval from weaning to oestrus was significantly longer in sows with the length of lactation 21-25 days than 26-30 days and 31-36 days and in primiparous than multiparous sows. The interval from weaning to oestrus was negatively correlated with the length of lactation (r=-0.21; P<0.05), parity (r=-0.36; P<0.01) and oestrus duration (r=-0.26; P<0.01). The weaning to oestrus interval, oestrus duration, parity and lactation length had a significant effect and the breed of sows had no influence on the vaginal impedance in peri-oestrus. The decrease of vaginal impedance after weaning was delayed in sows with a longer weaning to oestrus interval and in primiparous than multiparous sows. The decline of vaginal impedance during peri-oestrus was more gradual in sows with a longer interval from weaning to oestrus, shorter lactation, primiparous sows and sows with the length of oestrus 36 h and 72 h and more. The nadir of vaginal impedance occurred earlier before oestrus in sows with a shorter oestrus. The interaction of weaning to oestrus interval with parity and oestrus duration and the interaction of oestrus duration with parity significantly affected the vaginal impedance in weaned sows. In conclusion, the weaning to oestrus interval, oestrus duration, parity and lactation length considerably influence the vaginal impedance in sows during peri-oestrus. The findings indicate that the impedance technique may be a useful method for a study of factors and processes that accelerate or slow down the return to oestrus after weaning and affect oestrus duration in sows.     

Lactation and interbirth interval in the Senegal galago (Galago senegalensis moholi)

Five years of reproductive data on Galago senegalensis moholi at the Duke University Primate Center were examined to determine the effect of lactation on interbirth interval and its component phases, postpartum anovulatory interval and interval from onset of estrous cycles to conception. Females whose infants died within 3 weeks of birth had significantly shorter interbirth intervals and postpartum anovulatory intervals than did females who raised their infants until weaning.     

Vaginal rings for contraception in lactating women

Contraceptive methods for breastfeeding women should be safe for the mother and infant and should not interfere with lactation. Progestin-only methods meet these conditions and can be used from the sixth week postpartum. Because all progestins are excreted in milk, those that are insufficiently active by the oral route are preferable to avoid any possible effect on the baby. These steroids, however, must be administered to the mother by a non-oral route. Initially, progesterone was administered subdermally to test this concept. Subsequently, a progesterone vaginal ring was developed to be used continuously for 3 to 4 months and replaced with a new device, as needed, until weaning. Clinical trials have shown a high contraceptive efficacy (over 98.5%) and safety. The gross continuation rate of this method is approximately 40% at 12 months of use, with use-related problems being the main reason for discontinuation (26.8%). Currently, a Nestorone vaginal ring is under development, delivering 50 microg of Nestorone per day. It may be used continuously for up to one year, even if weaning occurs earlier. Both of these progestin-only rings prolong lactational amenorrhea to 10 to 12 months, which represents a health benefit and convenience for many women. The registration of the progesterone vaginal ring, developed as a contraceptive method to be used exclusively during lactation, has been approved in Chile and Perú. The fact that it is a user-controlled long-term contraceptive that delivers a natural hormone makes it an attractive option for many women.     

The effect of managed boar contact in the post-weaning period on the subsequent fertility and fecundity of sows

This study demonstrates, in the artificial insemination of weaned sows, the advantage of isolating sows from contact with boars from weaning until the fourth day after weaning and then introducing a boar to elicit the estrous display before insemination. Weaned sows were isolated from boar stimulation during the immediate post-weaning period (Day 0 = weaning) until Day 4, when they were introduced to full boar contact. Sows were inseminated immediately upon display of oestrus shown by back pressure test (0 h) and 24 h later. Fertility data were collected after parturition. This "segregated service management" (SSM) resulted in significantly improved farrowing rate and litter size (P < 0.001) compared with the results in the group that had conventional continuous contact with the boar. All other measured performance indicators were similar between the groups. The benefit of SSM is believed to be due to artificial insemination being timed more closely to ovulation or to a more certain identification of true oestrus and/or improved sperm transport in the sow. SSM is recommended for enhancing the efficiency of boar-sow interaction to maximise fertility and fecundity at artificial insemination.     

The influence of insulin administration after weaning the first litter on ovulation rate and embryo survival in sows

Primiparous crossbred sows (n = 43), lactating for an average of 21.1 +/- 0.1 d and weaning 8.7 +/- 0.1 pigs, were used to evaluate the influence of insulin on ovulation rate and embryo survival. The sows were maintained on 2.3 kg/head/d of a 14% protein gestation diet during pregnancy, fed ad libitum during lactation, given 2.7 kg/head/d from weaning until re-breeding and fed 2.3 kg/head/d after mating. Beginning the day after weaning (Day 0) sows were treated with 0.4 IU/kg body weight (BW) insulin (n = 21) or were administered an equivalent volume of saline (n = 22) for 4 d. Beginning on Day 3 and continuing until Day 14 after weaning, the sows were checked for estrus twice daily and were artificially inseminated using pooled semen from 2 fertile boars. At slaughter (days 30 to 40 of gestation), ovaries and uteri were collected, and the ovulation rate, embryo number and viability, and uterine weight and length were evaluated and recorded. Use of insulin decreased the average interval from weaning to estrus compared with saline by increasing percentage in estrus by Day 14 after weaning (5.0 +/- 0.57 vs 6.9 +/- 0.56 d, respectively; P < 0.03). Ovulation rate, number of embryos, embryo survival, and average uterine length and weight were not influenced by insulin treatment. Overall, insulin affected reproductive efficiency in primiparous sows by increasing the percentage of sows in estrus.     

Responses to n-3 fatty acid (LCPUFA) supplementation of gestating gilts,and lactating and weaned sows

Feeding n-3 long-chain polyunsaturated fatty acids (LCPUFA) to gilts or sows has shown different responses to litter growth, pre-weaning mortality and subsequent reproductive performance of the sow. Two hypotheses were tested: (1) that feeding a marine oil-based supplement rich in protected n-3 LCPUFAs to gilts in established gestation would improve the growth performance of their litters; and (2) that continued feeding of the supplement during lactation and after weaning would offset the negative effects of lactational catabolism induced, using an established experimental model involving feed restriction of lactating primiparous sows. A total of 117 primiparous sows were pair-matched at day 60 of gestation by weight, and when possible, litter of origin, and were allocated to be either control sows (CON) fed standard gestation and lactation diets, or treated sows (LCPUFA) fed the standard diets supplemented with 84 g/day of a n-3 LCPUFA rich supplement, from day 60 of first gestation, through a 21-day lactation, and until euthanasia at day 30 of their second gestation. All sows were feed restricted during the last 7 days of lactation to induce catabolism, providing a background challenge against which to determine beneficial effects of n-3 LCPUFA supplementation on subsequent reproduction. In the absence of an effect on litter size or birth weight, n-3 LCPUFA tended to improve piglet BW gain from birth until 34 days after weaning (P = 0.06), while increasing pre-weaning mortality (P = 0.05). It did not affect energy utilization by the sow during lactation, thus not improving the catabolic state of the sows. Supplementation from weaning until day 30 of second gestation did not have an effect on embryonic weight, ovulation rate or early embryonic survival, but did increase corpora lutea (CL) weight (P = 0.001). Eicosapentaenoic acid and docosahexaenoic acid (DHA) levels were increased in sow serum and CL (P < 0.001), whereas only DHA levels increased in embryos (P < 0.01). In conclusion, feeding n-3 LCPUFA to gilts tended to improve litter growth, but did not have an effect on overall subsequent reproductive performance.     

Effects of dietary enrichment with a marine oil-based n-3 LCPUFA supplement in sows with predicted birth weight phenotypes on growth performance and carcass quality of offspring

Effects of a marine oil-based n-3 LCPUFA supplement (mLCPUFA) fed from weaning until the end of the next lactation to sows with a predicted low litter birth weight (LBW) phenotype on growth performance and carcass quality of litters born to these sows were studied, based on the hypothesis that LBW litters would benefit most from mLCPUFA supplementation. Sows were allocated to be fed either standard corn/soybean meal-based gestation and lactation diets (CON), or the same diets enriched with 0.5% of the mLCPUFA supplement at the expense of corn. The growth performance from birth until slaughter of the litters with the lowest average birth weight in each treatment (n=24 per treatment) is reported in this paper. At weaning, each litter was split between two nursery pens with three to six pigs per pen. At the end of the 5-week nursery period, two barrows and two gilts from each litter that had individual birth weights closest to their litter average birth weight, were moved to experimental grow–finish pens (barn A), where they were housed as two pigs per pen, sorted by sex within litter. Remaining pigs in each litter were moved to another grow–finish barn (barn B) and kept in mixed-sex pens of up to 10 littermates. After 8 weeks, one of the two pigs in each pen in barn A was relocated to the pens holding their respective littermates in barn B. The remaining barrows and gilts were individually housed in the pens in barn A until slaughter. Maternal mLCPUFA supplementation increased docosahexaenoic acid (DHA) concentration in the brain, liver and Semitendinosus muscle of stillborn pigs (P<0.01), did not affect eicosapentaenoic acid and DHA concentrations in sow serum at the end of lactation, and did not affect average daily gain, average daily feed intake or feed utilization efficiency of the offspring. BW was higher (P<0.01) in the second half of the grow–finish phase in pigs from mLCPUFA sows compared with controls in barn A, where space and competition for feed was minimal, but not barn B. Carcass quality was not affected by treatment for pigs from barn A, but maternal mLCPUFA supplementation negatively affected carcass quality in pigs from barn B. Collectively, these results suggest that nutritional supplementation of sows can have lasting effects on litter development, but that feeding mLCPUFA to sows during gestation and lactation was not effective in improving growth rates or carcass quality of LBW litters.     

Breast reconstruction with postmastectomy radiation therapy: current issues

Two recent trials have demonstrated superior locoregional control, disease-free survival, and overall survival in node-positive breast cancer patients with the addition of postmastectomy radiation therapy to mastectomy and chemotherapy. Based on these results, there has been an increased use of postmastectomy in patients with early-stage breast cancer. The inability to determine which patients will require postmastectomy radiation therapy has increased the complexity of planning for immediate breast reconstruction. There are two potential problems with performing an immediate breast reconstruction in a patient who will require postmastectomy radiation therapy. One problem is that postmastectomy radiation therapy can adversely affect the aesthetic outcome of an immediate breast reconstruction. Several studies have evaluated the outcomes of breast reconstructions that were performed before radiation therapy and have revealed a high incidence of complications and poor aesthetic outcomes. Furthermore, these studies have found that often an additional flap is required to restore breast shape and symmetry. The other potential problem is that an immediate breast reconstruction can interfere with the delivery of postmastectomy radiation therapy. During planning for immediate breast reconstruction, it is imperative to carefully review the stage of disease and the likelihood the patient will require postmastectomy radiation therapy. Unfortunately, the ability to detect and predict the presence or extent of axillary lymph node involvement is limited, and the need for postmastectomy radiation therapy is usually not known until after mastectomy. In all cases of decision making regarding possible postoperative radiation therapy and whether or not to perform immediate breast reconstruction, the situation should be discussed at a multidisciplinary conference or addressed among the various medical, surgical, and radiation teams, with active participation by the patient. Immediate breast reconstruction probably should be avoided in patients known to require postmastectomy radiation therapy and delayed until it is certain the therapy will be needed in patients who may require the therapy.     

Natural and abrupt involution of the mammary gland affects differently the metabolic and health consequences of weaning

In most mammals under natural conditions weaning is gradual. Weaning occurs after the mammary gland naturally produces much less milk than it did at peak and established lactation. Involution occurs following the cessation of milk evacuation from the mammary glands. The abrupt termination of the evacuation of milk from the mammary gland at peak and established lactation induces abrupt involution. Evidence on mice has shown that during abrupt involution, mammary gland utilizes some of the same tissue remodeling programs that are activated during wound healing. These results led to the proposition of the “involution hypothesis”. According to the involution hypothesis, involution is associated with increased risk for developing breast cancer. However, the involution hypothesis is challenged by the metabolic and immunological events that characterize the involution process that follows gradual weaning. It has been shown that gradual weaning is associated with pre-adaption to the forthcoming break between dam and offspring and is followed by an orderly reprogramming of the mammary gland tissue. As discussed herein, such response may actually protect the mammary glands against the development of breast cancer and thus, may explain the protective effect of extended breastfeeding. On the other hand, the termination of breastfeeding during the first 6 months of lactation is likely associated with an abrupt involution and thus with an increased risk for developing breast cancer. Review of the literature on the epidemiology of breast cancer principally supports those conclusions.