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India is witnessing a demographic shift: women are marrying and bearing children later. As an oncologist I see two linked consequences a higher lifetime risk of hormone-sensitive breast cancer linked to delayed first childbirth, and a clinical challenge when cancer and recent pregnancy intersect. Large epidemiologic studies show that having a first full-term pregnancy at older ages raises breast-cancer risk compared with early childbirth; classic cohort analyses and modern reviews estimate substantially higher risk when first birth occurs after age 30–35.

In the Indian setting, case–control and meta-analytic work confirms age at first pregnancy as a measurable risk factor alongside rising incidence in younger women, a trend driven by urbanisation, later marriage, and reproductive choices. Clinically important: pregnancy causes short-term increases in breast-cancer incidence (pregnancy-associated breast cancer, PABC) and older maternal age amplifies a transient postpartum risk peak; these cancers are often diagnosed at a later stage because physiological breast changes mask lumps.

What practical advice do I give patients and families? First, prevention and risk reduction matter: breastfeeding is protective, every additional 12 months lowers risk modestly; so promoting and supporting breastfeeding remains high-value public health advice. Second, reproductive counselling must include oncologic perspective: women at high genetic or familial risk should receive early risk assessment and discussion of fertility preservation options before therapy; oncologists in India increasingly follow ASCO recommendations to offer onco-fertility counselling.

From experience in a busy cancer centre, I also stress systems-level changes: we need better awareness among obstetricians and primary care doctors to evaluate persistent breast changes during and after pregnancy, faster referral pathways for young symptomatic women, and culturally sensitive counselling that balances family planning with cancer risk. Early detection, not alarmism-saves lives and preserves choices.

Dr.Pritam Kalaskar
M.D D.M
Consultant Cancer Physician
MOC Cancer Care & Research Centre, Thane .