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Braam W, Spruyt K. Reference intervals for 6-Sulfatoxymelatonin in urine: a meta-analysis. Sleep Med Rev 2022; 63:101614. [DOI: 10.1016/j.smrv.2022.101614] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 02/16/2022] [Accepted: 02/16/2022] [Indexed: 12/11/2022]
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2
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Protective role of melatonin in breast cancer: what we can learn from women with blindness. Cancer Causes Control 2021; 33:1-13. [PMID: 34837156 DOI: 10.1007/s10552-021-01502-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/28/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE This review proposes an overall vision of the protective and therapeutic role of melatonin in breast cancer: from the specific cases of blind women and their reduction of breast cancer incidence to all clinical uses of the sleep hormone in breast cancer. METHODS We reviewed studies focused on (1) the correlation between blindness and breast cancer, (2) the correlation between melatonin and breast cancer occurrence in the general population, (3) melatonin therapeutic use in breast cancer, and (4) we discussed the properties of melatonin that could explain an anticancer effect. RESULTS (1) Seven studies of breast cancer risk in blind women related significant incidence decreases, up to 57%, among totally blind women. The limited number of studies and the absence of adjustment for confounding factors in most studies limit conclusions. None of these studies established melatonin profiles to determine whether blind women with a decreased breast cancer incidence produced higher levels of melatonin. (2) In the general population, 5 meta-analyses and 12 prospective-cohort studies focused on melatonin levels at recruitment and breast cancer occurrence. All reported the absence of correlation in premenopausal women, whereas in postmenopausal women, most studies showed significantly decreased risk for women with highest melatonin levels. (3) The therapeutic interest of melatonin associated with chemotherapy, radiotherapy, and hormonotherapy is poorly documented in breast cancer to conclude on a positive effect. (4) Melatonin effects on mammary carcinogenesis were only reported in in vitro and animal studies that demonstrated antiestrogenic, antioxidant, oncostatic, and immunomodulatory properties. CONCLUSION The preventive role of high endogenous melatonin on breast cancer as well as its beneficial therapeutic use remains to be proven.
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Lee CC, Kuo YC, Hu JM, Chang PK, Sun CA, Yang T, Li CW, Chen CY, Lin FH, Hsu CH, Chou YC. MTNR1B polymorphisms with CDKN2A and MGMT methylation status are associated with poor prognosis of colorectal cancer in Taiwan. World J Gastroenterol 2021; 27:5737-5752. [PMID: 34629798 PMCID: PMC8473598 DOI: 10.3748/wjg.v27.i34.5737] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/30/2021] [Accepted: 08/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Identifying novel colorectal cancer (CRC) prognostic biomarkers is crucial to helping clinicians make appropriate therapy decisions. Melatonin plays a major role in managing the circadian rhythm and exerts oncostatic effects on different kinds of tumours.
AIM To explore the relationship between MTNR1B single-nucleotide polymorphism (SNPs) combined with gene hypermethylation and CRC prognosis.
METHODS A total of 94 CRC tumour tissues were investigated. Genotyping for the four MTNR1B SNPs (rs1387153, rs2166706, rs10830963, and rs1447352) was performed using multiplex polymerase chain reaction. The relationships between the MTNR1B SNPs and CRC 5-year overall survival (OS) was assessed by calculating hazard ratios with 95%CIs.
RESULTS All SNPs (rs1387153, rs2166706, rs10830963, and rs1447352) were correlated with decreased 5-year OS. In stratified analysis, rs1387153, rs10830963, and rs1447352 risk genotype combined with CDKN2A and MGMT methylation status were associated with 5-year OS. A strong cumulative effect of the four polymorphisms on CRC prognosis was observed. Four haplotypes of MTNR1B SNPs were also associated with the 5-year OS. MTNR1B SNPs combined with CDKN2A and MGMT gene methylation status could be used to predict shorter CRC survival.
CONCLUSION The novel genetic biomarkers combined with epigenetic biomarkers may be predictive tool for CRC prognosis and thus could be used to individualise treatment for patients with CRC.
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Affiliation(s)
- Chia-Cheng Lee
- Division of Colorectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
- Medical Informatics Office, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Yu-Cheng Kuo
- School of Public Health, National Defense Medical Center, Taipei 114, Taiwan
| | - Je-Ming Hu
- Division of Colorectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Pi-Kai Chang
- Division of Colorectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Chien-An Sun
- Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City 24205, Taiwan
- Big Data Research Center, College of Medicine, Fu-Jen Catholic University, New Taipei City 24205, Taiwan
| | - Tsan Yang
- Department of Health Business Administration, Meiho University, Pingtung 91202, Taiwan
| | - Chuan-Wang Li
- Department and Graduate Institute of Microbiology and Immunology, National Defense Medical Center, Taipei 114, Taiwan
- Institute of Preventive Medicine, National Defense Medical Center, New Taipei City 237, Taiwan
| | - Chao-Yang Chen
- Division of Colorectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Fu-Huang Lin
- School of Public Health, National Defense Medical Center, Taipei 114, Taiwan
| | - Chih-Hsiung Hsu
- School of Public Health, National Defense Medical Center, Taipei 114, Taiwan
| | - Yu-Ching Chou
- School of Public Health, National Defense Medical Center, Taipei 114, Taiwan
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Zhang N, Sundquist J, Sundquist K, Ji J. Use of Melatonin Is Associated With Lower Risk of Colorectal Cancer in Older Adults. Clin Transl Gastroenterol 2021; 12:e00396. [PMID: 34342302 PMCID: PMC8337060 DOI: 10.14309/ctg.0000000000000396] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/12/2021] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Preclinical evidence suggests that melatonin may affect cellular pathways involved in colorectal cancer (CRC). We sought to test whether melatonin use was associated with decreased risk of CRC using population-based data. METHODS We performed a nationwide cohort study using a new-user study design. We identified a total of 58,657 incident melatonin users aged 50 years and older from the Prescribed Drug Register, and matched them with 175,971 comparisons who did not use melatonin, on the ratio of 1:3. The Cox regression model was used to calculate hazard ratios and 95% confidence intervals. RESULTS The incidence rate of CRC was 10.40 per 10,000 person-years for melatonin users, whereas the rate was 12.82 per 10,000 person-years in the nonusers. We found a significant negative association between melatonin use and risk of CRC (adjusted hazard ratio, 0.82; 95% confidence interval, 0.72-0.92). A test for trend showed a significant dose-response correlation (P < 0.001). The decrease of CRC risk was independent of tumor location and stage at diagnosis. When stratified by age groups, the inverse association was significant only among individuals aged 60 years and older. DISCUSSION This population-based cohort study suggests that the use of melatonin was associated with a reduced risk of CRC. Further studies are needed to confirm the observed association and to explore the underlying mechanisms.
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Affiliation(s)
- Naiqi Zhang
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Sweden;
| | - Jan Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Sweden;
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Center for Community-Based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Japan
| | - Kristina Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Sweden;
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Center for Community-Based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Japan
| | - Jianguang Ji
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Sweden;
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Wong ATY, Fensom GK, Key TJ, Onland-Moret NC, Tong TYN, Travis RC. Urinary Melatonin in Relation to Breast Cancer Risk: Nested Case-Control Analysis in the DOM Study and Meta-analysis of Prospective Studies. Cancer Epidemiol Biomarkers Prev 2020; 30:97-103. [PMID: 33144281 DOI: 10.1158/1055-9965.epi-20-0822] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/04/2020] [Accepted: 10/16/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Exposure to higher levels of melatonin may be associated with lower breast cancer risk, but epidemiologic evidence has been limited. We examined the relationship in a case-control study nested within the Diagnostisch Onderzoek Mammacarcinoom (DOM) study and conducted a meta-analysis of prospective studies. METHODS Concentrations of 6-sulfatoxymelatonin (aMT6s) in prediagnostic first morning urine voids were measured in 274 postmenopausal women diagnosed with breast cancer and 274 matched controls from the DOM study. Conditional logistic regression models were used to estimate multivariable adjusted ORs of breast cancer for thirds of aMT6s. Meta-analysis of this and previous prospective studies of urinary melatonin with breast cancer risk estimated the inverse-variance weighted averages of study-specific log RRs of breast cancer for the highest versus lowest levels of aMT6s. RESULTS In the DOM study, the ORs of breast cancer for the middle and highest versus lowest thirds of aMT6s were 0.70 [95% confidence interval (CI), 0.45-1.09] and 0.72 (95% CI, 0.44-1.19), respectively. In the meta-analysis of the DOM study with six previous studies (2,296 cases), RR of breast cancer for the highest versus lowest levels of aMT6s was 0.87 (95% CI, 0.76-1.01). CONCLUSIONS Results from the DOM study, together with the published prospective data, do not support a strong association of melatonin with breast cancer risk. IMPACT This study adds to the relatively scarce prospective data on melatonin in relation to breast cancer risk. The totality of the prospective evidence does not clearly show an association between melatonin and breast cancer risk, but further data are needed to be able to exclude a modest association.
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Affiliation(s)
- Angel T Y Wong
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, England, United Kingdom.
| | - Georgina K Fensom
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, England, United Kingdom
| | - Timothy J Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, England, United Kingdom
| | | | - Tammy Y N Tong
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, England, United Kingdom
| | - Ruth C Travis
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, England, United Kingdom
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Zaki NFW, Sabri YM, Farouk O, Abdelfatah A, Spence DW, Bahammam AS, Pandi-Perumal SR. Depressive Symptoms, Sleep Profiles and Serum Melatonin Levels in a Sample of Breast Cancer Patients. Nat Sci Sleep 2020; 12:135-149. [PMID: 32104121 PMCID: PMC7025675 DOI: 10.2147/nss.s206768] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 12/02/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Chronobiological changes have been detected in various physiological functions of patients with breast cancer, suggesting dysregulation in the pineal gland and melatonin secretion. This study aimed to assess and measure serum melatonin levels pre- and postoperatively in patients who had been diagnosed for the first time with breast cancer. METHODS A sample of first-time breast cancer patients, consisting of 45 women aged 25-65 years, was evaluated and psychometric assessment was completed using the Beck Depression Inventory (BDI), Insomnia Severity Index (White, Weinberg et al) and the Epworth Sleepiness Scale (Cardoso, Spence et al). The Morningness-Eveningness questionnaire (MEQ) was used to assess the chronotype. Serum melatonin levels were measured by radioimmunoassay. RESULTS Morning and moderately morning chronotypes were prevalent among the sample (25%, 45.8%, respectively). The finding of a mean BDI score of 13.5±11.2 indicated that depressive symptoms were prevalent among the sample. Despite the finding that a mean of the participants apparently had no symptoms of daytime sleepiness (the mean and standard deviations of the ESS were 7.5±4.4), scores on the ISI (a mean of 16.7±SD 7.3) indicated that insomnia symptoms were prevalent in the sample. Melatonin levels showed an inverse relationship with insomnia severity as measured by the ISI and depression severity, as assessed by the BDI. The postoperative melatonin levels were higher than the preoperative levels. Additionally, the psychometric profile differed among various pathological types of breast cancer according to their hormone receptor profile. CONCLUSION Serum melatonin levels correlated significantly with self-reported sleep quality and psychometric profiles of depression in the present sample of breast cancer patients. The melatonin assay, which is relatively easy to carry out, provided a convenient, objective measure of an important biological correlate of sleep quality and depression. This assay thus represented a confirmatory alternative to the self-report instruments, which may sometimes be unreliable. Future studies should further evaluate the utility of melatonin measures in psychiatric and sleep complaints of breast cancer patients.
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Affiliation(s)
- Nevin FW Zaki
- Sleep Research Unit, Department of Psychiatry, Faculty of Medicine, Mansoura University, Mansoura, Egypt
- Department of Psychiatry, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Yomna M Sabri
- Department of Psychiatry, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Omar Farouk
- Mansoura University Oncology Center, Mansoura, Egypt
| | - Amany Abdelfatah
- Clinical Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | - Ahmed S Bahammam
- University Sleep Disorders Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- The Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation in the Kingdom of Saudi Arabia, Riyadh, Saudi Arabia
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Shigesato M, Kawai Y, Guillermo C, Youkhana F, Shvetsov YB, Setiawan VW, Haiman CA, Le Marchand L, Maskarinec G. Association between sleep duration and breast cancer incidence: The multiethnic cohort. Int J Cancer 2020; 146:664-670. [PMID: 30895617 PMCID: PMC6754321 DOI: 10.1002/ijc.32292] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 02/12/2019] [Accepted: 03/04/2019] [Indexed: 12/27/2022]
Abstract
Breast cancer is the most common cancer and the second-leading cause of cancer-related death among women. Inconsistent findings for the relationship between melatonin levels, sleep duration and breast cancer have been reported. We investigated the association of sleep duration at cohort entry and its interaction with body mass index (BMI) with risk of developing breast cancer in the large population-based Multiethnic Cohort study. Among the 74,481 at-risk participants, 5,790 breast cancer cases were identified during the study period. Although we detected no significant association between sleep duration and breast cancer incidence, higher risk estimates for short (HR = 1.03; 95% CI: 0.97-1.09) and long sleep (HR = 1.05; 95% CI: 0.95-1.15) compared to normal sleep (7-8 hr) were found. The patterns for models stratified by age, BMI, ethnicity and hormone receptor status were similar but did not indicate significant interaction effects. When examining the combined sleep duration and BMI interaction effect, in comparison to the normal BMI-normal sleep group, risk estimates for underweight, overweight and obesity were similar across categories of sleep duration (≤6, 7-8, and ≥9 hr). The underweight-normal sleep group had lower breast cancer incidence (HR = 0.66, 95% CI: 0.50-0.86), whereas the overweight-short sleep, overweight-normal sleep group and all obese women experienced elevated breast cancer incidence. The respective HRs for short, normal and long sleep among obese women were 1.35 (95% CI: 1.20-1.53), 1.27 (95% CI: 1.15-1.42) and 1.46 (95% CI: 1.21-1.76). Future perspectives need to examine the possibility that sleep quality, variations in circadian rhythm and melatonin are involved in breast cancer etiology.
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Affiliation(s)
- Maryssa Shigesato
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Yosuke Kawai
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Cherie Guillermo
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Fadi Youkhana
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Yurii B. Shvetsov
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Veronica W. Setiawan
- Department of Preventive Medicine, Keck School of Medicine, and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Christopher A. Haiman
- Department of Preventive Medicine, Keck School of Medicine, and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Loïc Le Marchand
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA
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8
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Night Shift Work and Risk of Breast Cancer in Women. Arch Med Res 2019; 50:393-399. [PMID: 31689664 DOI: 10.1016/j.arcmed.2019.10.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 10/22/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND Night shift work involving circadian disruption has been associated with increased breast cancer rates in some epidemiological studies, but the evidence is still on debate. AIM OF THE STUDY The objective of this study is to assess the association between night shift work and breast cancer in Mexican women. METHODS A Case-control study was conducted with incident cases of breast cancer at the Instituto de Seguridad Social del Estado de México y Municipios. Cases were interviewed about past exposures prior to the final diagnosis. Controls were women without breast cancer matched on multiple sociodemographic characteristics. RESULTS 101 cases and 101 matched controls were interviewed; this small sample size provided consistent, but wide estimates of the assessed associations. The multivariate conditional logistic regression showed that breast-feeding was associated with reduced risk for breast cancer (OR 0.12; 95% CI: 0.02-0.60); women who experienced early menarche (12 years) were more likely to develop breast cancer (OR 18.58; 95% CI 18: 2.19-148). Women who worked at night were more likely to develop breast cancer compared to women who never did (OR = 8.58; 95% CI: 2.19-33.8). CONCLUSIONS Our results are consistent with studies from other countries, which positively associated night shift work with breast cancer.
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Haim A, Boynao S, Elsalam Zubidat A. Consequences of Artificial Light at Night: The Linkage between Chasing Darkness Away and Epigenetic Modifications. Epigenetics 2019. [DOI: 10.5772/intechopen.84789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
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Veiga ECDA, Simões R, Valenti VE, Cipolla-Neto J, Abreu LC, Barros EPM, Sorpreso ICE, Baracat MCP, Baracat EC, Soares Junior JM. Repercussions of melatonin on the risk of breast cancer: a systematic review and meta-analysis. Rev Assoc Med Bras (1992) 2019; 65:699-705. [DOI: 10.1590/1806-9282.65.5.699] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 11/04/2018] [Indexed: 12/17/2022] Open
Abstract
SUMMARY Breast Cancer is common in women, but its etiology is not yet fully understood. Several factors may contribute to its genesis, such as genetics, lifestyle, and the environment. Melatonin may be involved in the process of breast cancer. Therefore, the aim of this study is to evaluate the influence of the levels of melatonin on breast cancer through a systematic review and meta-analysis. We performed a systematic review according to PRISMA recommendations. The primary databases MEDLINE, Embase, and Cochrane were consulted. There was no restriction on the year of publication and language. Data of systematic reviews from April 2017 to September to 2017 were analyzed. The meta-analysis was conducted using RevMan 5.3 software provided by the Cochrane Collaboration. From a total of 570 articles, 9 manuscripts were included in this review. They analy onzed women with breast cancer and control patients, of which 10% and 90% were in the reproductive period and after menopause, respectively. The lowest level of melatonin was found in approximately 55% of studies with breast cancer in post-menopause. The metanalyses of the studies demonstrated low levels of melatonin in breast cancer patients (n=963) compared with control patients (n= 1332), with a mean difference between the studies of −3.54 (CI −6.01, −1.06). Another difference found was in the comparison between smoking patients, with an average difference between 1.80 [0.97-2.63]. Our data suggest that low levels of melatonin might be a risk factor for breast cancer.
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Li Y, Li S, Zhou Y, Meng X, Zhang JJ, Xu DP, Li HB. Melatonin for the prevention and treatment of cancer. Oncotarget 2018; 8:39896-39921. [PMID: 28415828 PMCID: PMC5503661 DOI: 10.18632/oncotarget.16379] [Citation(s) in RCA: 230] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 03/09/2017] [Indexed: 12/17/2022] Open
Abstract
The epidemiological studies have indicated a possible oncostatic property of melatonin on different types of tumors. Besides, experimental studies have documented that melatonin could exert growth inhibition on some human tumor cells in vitro and in animal models. The underlying mechanisms include antioxidant activity, modulation of melatonin receptors MT1 and MT2, stimulation of apoptosis, regulation of pro-survival signaling and tumor metabolism, inhibition on angiogenesis, metastasis, and induction of epigenetic alteration. Melatonin could also be utilized as adjuvant of cancer therapies, through reinforcing the therapeutic effects and reducing the side effects of chemotherapies or radiation. Melatonin could be an excellent candidate for the prevention and treatment of several cancers, such as breast cancer, prostate cancer, gastric cancer and colorectal cancer. This review summarized the anticancer efficacy of melatonin, based on the results of epidemiological,experimental and clinical studies, and special attention was paid to the mechanisms of action.
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Affiliation(s)
- Ya Li
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Sha Li
- School of Chinese Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Yue Zhou
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Xiao Meng
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Jiao-Jiao Zhang
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Dong-Ping Xu
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Hua-Bin Li
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Department of Nutrition, School of Public Health, Sun Yat-Sen University, Guangzhou, China.,South China Sea Bioresource Exploitation and Utilization Collaborative Innovation Center, Sun Yat-Sen University, Guangzhou, China
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12
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Melatonin and breast cancer: Evidences from preclinical and human studies. Crit Rev Oncol Hematol 2018; 122:133-143. [DOI: 10.1016/j.critrevonc.2017.12.018] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 10/20/2017] [Accepted: 12/27/2017] [Indexed: 12/22/2022] Open
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Xu J, Huang L, Sun GP. Urinary 6-sulfatoxymelatonin level and breast cancer risk: systematic review and meta-analysis. Sci Rep 2017; 7:5353. [PMID: 28706222 PMCID: PMC5509698 DOI: 10.1038/s41598-017-05752-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 06/02/2017] [Indexed: 12/14/2022] Open
Abstract
6-Sulfatoxymelatonin (aMT6s) is the main metabolite of melatonin in urine, and is a reliable surrogate biomarker reflecting the blood melatonin concentration. This meta-analysis assessed the association between urinary aMT6s level and BC incidence. The electronic databases PubMed, EMBASE, Cochrane Library, and Web of Science were searched. Risk ratios (RRs) were adopted to estimate the relative BC incidence. A total of 7 prospective case-control publications were included, and 6 of them were distinct studies. Pooled analysis of data from the 6 studies involving 1824 women with incident BC and 3954 matched control participants with no overlapping of subjects among studies indicated no significant association between the highest levels of urinary aMT6s and the incidence of BC (RR = 0.97, 95% CI, 0.88-1.08, P = 0.56). Negative associations were observed in postmenopausal women (RR = 0.88, 95% CI, 0.75-1.02, P = 0.10), estrogen receptor positive BC (RR = 0.83, 95% CI, 0.64-1.07, P = 0.15), and studies using 12-hour overnight urine (RR = 0.81, 95% CI, 0.61-1.07, P = 0.13), all with borderline significances. Lag time or invasive degree did not interfere with the results. There was no evident publication bias detected by the Egger's test and the funnel plot. Conclusively, the current evidence did not support a significant association between urinary aMT6s level and BC risk.
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Affiliation(s)
- Jing Xu
- Department of Medical Oncology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Lei Huang
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China.
| | - Guo-Ping Sun
- Department of Medical Oncology, the First Affiliated Hospital of Anhui Medical University, Hefei, China.
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Pedraza-Flechas AM, Lope V, Sánchez-Contador C, Santamariña C, Pedraz-Pingarrón C, Moreo P, Ederra M, Miranda-García J, Vidal C, Llobet R, Aragonés N, Salas-Trejo D, Pollán M, Pérez-Gómez B. High Mammographic Density in Long-Term Night-Shift Workers: DDM-Spain/Var-DDM. Cancer Epidemiol Biomarkers Prev 2017; 26:905-913. [DOI: 10.1158/1055-9965.epi-16-0507] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 07/08/2016] [Accepted: 01/13/2017] [Indexed: 11/16/2022] Open
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Devore EE, Warner ET, Eliassen AH, Brown SB, Beck AH, Hankinson SE, Schernhammer ES. Urinary Melatonin in Relation to Postmenopausal Breast Cancer Risk According to Melatonin 1 Receptor Status. Cancer Epidemiol Biomarkers Prev 2016; 26:413-419. [PMID: 28151704 DOI: 10.1158/1055-9965.epi-16-0630] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 10/28/2016] [Accepted: 10/29/2016] [Indexed: 11/16/2022] Open
Abstract
Background: Urinary melatonin levels have been associated with a reduced risk of breast cancer in postmenopausal women, but this association might vary according to tumor melatonin 1 receptor (MT1R) expression.Methods: We conducted a nested case-control study among 1,354 postmenopausal women in the Nurses' Health Study, who were cancer free when they provided first-morning spot urine samples in 2000 to 2002; urine samples were assayed for 6-sulfatoxymelatonin (aMT6s, a major metabolite of melatonin). Five-hundred fifty-five of these women developed breast cancer before May 31, 2012, and were matched to 799 control subjects. In a subset of cases, immunohistochemistry was used to determine MT1R status of tumor tissue. We used multivariable-adjusted conditional logistic regression to estimate the relative risk (RR) of breast cancer [with 95% confidence intervals (CI)] across quartiles of creatinine-standardized urinary aMT6s level, including by MT1R subtype.Results: Higher urinary melatonin levels were suggestively associated with a lower overall risk of breast cancer (multivariable-adjusted RR = 0.78; 95% CI = 0.61-0.99, comparing quartile 4 vs. quartile 1; Ptrend = 0.08); this association was similar for invasive vs. in situ tumors (Pheterogeneity = 0.12). There was no evidence that associations differed according to MT1R status of the tumor (e.g., Pheterogeneity for overall breast cancer = 0.88).Conclusions: Higher urinary melatonin levels were associated with reduced breast cancer risk in this cohort of postmenopausal women, and the association was not modified by MT1R subtype.Impact: Urinary melatonin levels appear to predict the risk of breast cancer in postmenopausal women. However, future research should evaluate these associations with longer-term follow-up and among premenopausal women. Cancer Epidemiol Biomarkers Prev; 26(3); 413-9. ©2016 AACR.
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Affiliation(s)
- Elizabeth E Devore
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
| | - Erica T Warner
- Clinical Translational Epidemiology Unit, Massachusetts General Hospital, Boston, Massachusetts
| | - A Heather Eliassen
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Susan B Brown
- Division of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Andrew H Beck
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Susan E Hankinson
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Division of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Eva S Schernhammer
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
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16
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Kerdelhué B, Forest C, Coumoul X. Dimethyl-Benz(a)anthracene: A mammary carcinogen and a neuroendocrine disruptor. BIOCHIMIE OPEN 2016; 3:49-55. [PMID: 29450131 PMCID: PMC5801823 DOI: 10.1016/j.biopen.2016.09.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 09/30/2016] [Indexed: 12/22/2022]
Abstract
Polycyclic Aromatic Hydrocarbons (PAHs) are potent carcinogens. Among these, dimethylbenz(a)anthracene (DMBA) is well known for its capacity to induce mammary carcinomas in female Sprague-Dawley (SD) rats. Ovariectomy suppresses the susceptibility of this model to DMBA, thus suggesting that the inducible action of the carcinogen depends on ovarian hormones. The promotion of DMBA-induced adenocarcinoma is accompanied by a series of neuroendocrine disruptions of both Hypothalamo-Pituitary-Gonadal (HPG) and Hypothalamo-Pituitary-Adrenal (HPA) axes and of the secretion of melatonin during the latency period of 2 months that precedes the occurrence of the first mammary tumor. The present review analyses the various neuroendocrine disruptions that occur along the HPG and the HPA axes, and the marked inhibitory effect of the carcinogen on melatonin secretion. The possible relationships between the neuroendocrine disruptions, which essentially consist in an increased pre-ovulatory secretion of 17β-estradiol and prolactin, associated with a marked reduction of melatonin secretion, and the decrease in gene expression of the receptors for aryl-hydrocarbons receptor (AhR) and 17β-estradiol (ERα; ERβ) are also discussed. Polycyclic Aromatic Hydrocarbons influence promotion of breast tumorigenesis. Dimethylbenz(a)anthracene (DMBA) alters neuroendocrine axes and melatonin secretion. DMBA modulates the activity of aryl hydrocarbon and 17β-estradiol receptors.
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Key Words
- ACTH, Adrenocorticotropic hormone
- ARNT, AhR nuclear translocator
- AhR, Aryl hydrocarbon Receptor
- CRH, Corticotropin releasing hormone
- CYP, Cytochromes P450
- DMBA, Dimethylbenz(a)anthracene
- Dimethylbenz(a)anthracene
- E2, 17β-estradiol
- ERα and ERβ, Estrogen receptor
- FSH, Folliculo-Stimulating Hormone
- Female rat
- GnRH, Gonadotropin-Releasing Hormone
- HPA, Hypothalamo-Pituitary-Adrenal
- HPG, Hypothalamo-Pituitary-Gonadal
- LH, Luteinizing hormone
- Mammary cancer
- Neuroendocrine disruption
- PAHs, Polycyclic Aromatic Hydrocarbons
- PRL, Prolactin
- SD, Sprague-Dawley
- TCDD, 2,3,7,8-tetrachlorodibenzo-p-dioxin
- XRE, Xenobiotic response elements
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Affiliation(s)
- Bernard Kerdelhué
- CNRS UMR 8601, Chimie et Biochimie Pharmacologiques et Toxicologiques, Université Paris Descartes, Faculté des Sciences Fondamentales et Biomédicales, 45 rue des Saints Pères, 75006 Paris, France
- Corresponding author.
| | - Claude Forest
- INSERM UMR-S 1124, Université Paris Descartes, PRES Sorbonne Paris Cité, Pharmacologie Toxicologie et Signalisation Cellulaire, Faculté des Sciences Fondamentales et Biomédicales, 45 rue des Saints Pères, 75006 Paris, France
| | - Xavier Coumoul
- INSERM UMR-S 1124, Université Paris Descartes, PRES Sorbonne Paris Cité, Pharmacologie Toxicologie et Signalisation Cellulaire, Faculté des Sciences Fondamentales et Biomédicales, 45 rue des Saints Pères, 75006 Paris, France
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17
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Hughes V. Safe night-shift work. Nurs Manag (Harrow) 2016; 47:30-36. [PMID: 27465965 DOI: 10.1097/01.numa.0000488857.54323.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Vickie Hughes
- Vickie Hughes is an associate professor at Appalachian State University in Boone, N.C
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18
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Tai SY, Huang SP, Bao BY, Wu MT. Urinary melatonin-sulfate/cortisol ratio and the presence of prostate cancer: A case-control study. Sci Rep 2016; 6:29606. [PMID: 27387675 PMCID: PMC4937372 DOI: 10.1038/srep29606] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 06/22/2016] [Indexed: 12/29/2022] Open
Abstract
The circadian-related hormones, melatonin and cortisol, have oncostatic and immunosuppressive properties. This study examined the relationship between these two biomarkers and the presence of prostate cancer. We measured their major metabolites in urine collected from 120 newly diagnosed prostate cancer patients and 240 age-matched controls from January 2011 to April 2014. Compared with patients with lower urinary melatonin-sulfate or melatonin-sulfate/cortisol (MT/C) ratio levels, those with above-median levels were significantly less likely to have prostate cancer (adjusted OR (aOR) = 0.59, 95% CI = 0.35–0.99; aOR = 0.46, 95% CI: 0.27–0.77) or advanced stage prostate cancer (aOR = 0.49, 95% CI = 0.26–0.89; aOR = 0.33, 95% CI = 0.17–0.62). The combined effect of both low MT/C ratios and PSA levels exceeding 10 ng/ml was an 8.82-fold greater likelihood of prostate cancer and a 32.06-fold greater likelihood of advanced stage prostate cancer, compared to those with both high MT/C ratios and PSA levels less than 10 ng/ml. In conclusion, patients with high melatonin-sulfate levels or a high MT/C ratio were less likely to have prostate cancer or advanced stage prostate. Besides, a finding of a low MT/C ratio combined with a PSA level exceeding 10 ng/ml showed the greatest potential in detecting prostate cancer and advanced stage prostate cancer.
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Affiliation(s)
- Shu-Yu Tai
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Family Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Family Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.,Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shu-Pin Huang
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Institute of Biomedical Science, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Bo-Ying Bao
- Department of Pharmacy, China Medical University, Taichung, Taiwan.,Sex Hormone Research Center, China Medical University Hospital, Taichung, Taiwan.,Department of Nursing, Asia University, Taichung, Taiwan
| | - Ming-Tsang Wu
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Public Health, Kaohsiung Medical University, Kaohsiung Medical University, Kaohsiung, Taiwan.,Center of Environmental and Occupational Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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19
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Smolensky MH, Sackett-Lundeen LL, Portaluppi F. Nocturnal light pollution and underexposure to daytime sunlight: Complementary mechanisms of circadian disruption and related diseases. Chronobiol Int 2015; 32:1029-48. [PMID: 26374931 DOI: 10.3109/07420528.2015.1072002] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Routine exposure to artificial light at night (ALAN) in work, home, and community settings is linked with increased risk of breast and prostate cancer (BC, PC) in normally sighted women and men, the hypothesized biological rhythm mechanisms being frequent nocturnal melatonin synthesis suppression, circadian time structure (CTS) desynchronization, and sleep/wake cycle disruption with sleep deprivation. ALAN-induced perturbation of the CTS melatonin synchronizer signal is communicated maternally at the very onset of life and after birth via breast or artificial formula feedings. Nighttime use of personal computers, mobile phones, electronic tablets, televisions, and the like--now epidemic in adolescents and adults and highly prevalent in pre-school and school-aged children--is a new source of ALAN. However, ALAN exposure occurs concomitantly with almost complete absence of daytime sunlight, whose blue-violet (446-484 nm λ) spectrum synchronizes the CTS and whose UV-B (290-315 nm λ) spectrum stimulates vitamin D synthesis. Under natural conditions and clear skies, day/night and annual cycles of UV-B irradiation drive corresponding periodicities in vitamin D synthesis and numerous bioprocesses regulated by active metabolites augment and strengthen the biological time structure. Vitamin D insufficiency and deficiency are widespread in children and adults in developed and developing countries as a consequence of inadequate sunlight exposure. Past epidemiologic studies have focused either on exposure to too little daytime UV-B or too much ALAN, respectively, on vitamin D deficiency/insufficiency or melatonin suppression in relation to risk of cancer and other, e.g., psychiatric, hypertensive, cardiac, and vascular, so-called, diseases of civilization. The observed elevated incidence of medical conditions the two are alleged to influence through many complementary bioprocesses of cells, tissues, and organs led us to examine effects of the totality of the artificial light environment in which humans reside today. Never have chronobiologic or epidemiologic investigations comprehensively researched the potentially deleterious consequences of the combination of suppressed vitamin D plus melatonin synthesis due to life in today's man-made artificial light environment, which in our opinion is long overdue.
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Affiliation(s)
- Michael H Smolensky
- a Department of Biomedical Engineering , Cockrell School of Engineering, The University of Texas at Austin , Austin , TX , USA
| | - Linda L Sackett-Lundeen
- b American Association for Clinical Chronobiology and Chronotherapeutics , Roseville , MN , USA , and
| | - Francesco Portaluppi
- c Hypertension Center, S. Anna University Hospital, University of Ferrara , Ferrara , Italy
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20
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Abstract
PURPOSE Melatonin has anti-carcinogenic properties, including modulation of estradiol production, cell cycle regulation, and promotion of apoptosis. Urinary melatonin has been inversely associated with breast cancer in some studies, but the association with ovarian cancer has not been investigated. METHODS We measured urinary 6-sulfatoxymelatonin (aMT6s) in nested ovarian cancer case-control studies in the Nurses' Health Study (NHS; n = 100 cases; 199 controls) and NHSII (n = 52 cases; 105 controls); samples were mainly from first morning voids. Controls were matched to cases on year of birth, menopause status, use of menopausal hormone therapy, and urine collection characteristics. We evaluated the association of tertiles of aMT6s, corrected for creatinine concentrations, with risk of ovarian cancer using conditional logistic regression. Models were adjusted for key ovarian cancer risk factors, and we additionally evaluated adjustment for usual sleep duration, snoring, and history of rotating night shift work. RESULTS aMT6s was not significantly associated with risk of ovarian cancer. In multivariable models, the odds ratio comparing the highest tertile of aMT6s to the lowest was 0.79, 95 % confidence interval (CI) 0.40-1.56 in the NHS and 2.88, and 95 % CI in the NHSII 0.97-8.52. Additional adjustment for sleep habits and night shift work had little impact on the observed results. We observed no clear association between urinary melatonin and ovarian cancer risk. CONCLUSIONS These results are consistent with our previous study in which we reported no association between night shift work and ovarian cancer; however, given the small sample size in our study, additional evaluation in larger studies is warranted.
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21
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Aronson KJ, Grundy A, Korsiak J, Spinelli JJ. Causes of breast cancer: could work at night really be a cause? BREAST CANCER MANAGEMENT 2015. [DOI: 10.2217/bmt.15.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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22
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Ramin CA, Massa J, Wegrzyn LR, Brown SB, Pierre-Paul J, Devore EE, Hankinson SE, Schernhammer ES. The association of body size in early to mid-life with adult urinary 6-sulfatoxymelatonin levels among night shift health care workers. BMC Public Health 2015; 15:467. [PMID: 25943349 PMCID: PMC4424517 DOI: 10.1186/s12889-015-1770-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 04/21/2015] [Indexed: 12/04/2022] Open
Abstract
Background Adult body mass index (BMI) has been associated with urinary melatonin levels in humans; however, whether earlier-life body size is associated with melatonin, particularly among night shift workers, remains unknown. Methods We evaluated associations of birth weight, body shape (or somatotype) at ages 5 and 10, BMI at age 18 and adulthood, weight change since age 18, waist circumference, waist to hip ratio, and height with creatinine-adjusted morning urinary melatonin (6-sulfatoxymelatonin, aMT6s) levels among 1,343 healthy women (aged 32–53 at urine collection, 1996–1999) in the Nurses’ Health Study (NHS) II cohort. Using multivariable linear regression, we computed least-square mean aMT6s levels across categories of body size, and evaluated whether these associations were modified by night shift work. Results Adult BMI was inversely associated with aMT6s levels (mean aMT6s levels = 34 vs. 50 ng/mg creatinine, comparing adult BMI ≥30 vs. <20 kg/m2; Ptrend <0.0001); however, other measures of body size were not related to aMT6s levels after accounting for adult BMI. Night shifts worked prior to urine collection, whether recent or cumulatively over time, did not modify the association between adult BMI and aMT6s levels (e.g., Pinteraction = 0.72 for night shifts worked within two weeks of urine collection). Conclusions Our results suggest that adult BMI, but not earlier measures of body size, is associated with urinary aMT6s levels in adulthood. These observations did not vary by night shift work status, and suggest that adult BMI may be an important mechanism by which melatonin levels are altered and subsequently influence chronic disease risk.
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Affiliation(s)
- Cody A Ramin
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Avenue, Boston, MA, 02115, USA.
| | - Jennifer Massa
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA.
| | - Lani R Wegrzyn
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
| | - Susan B Brown
- Division of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA, USA.
| | | | - Elizabeth E Devore
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Avenue, Boston, MA, 02115, USA.
| | - Susan E Hankinson
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Avenue, Boston, MA, 02115, USA. .,Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA. .,Division of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA, USA.
| | - Eva S Schernhammer
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Avenue, Boston, MA, 02115, USA. .,Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA. .,Applied Cancer Research - Institution for Translational Research Vienna (ACR-ITR VIEnna), Vienna, Austria.
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