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Brown JA, Ish JL, Chang CJ, Bookwalter DB, O’Brien KM, Jones RR, Kaufman JD, Sandler DP, White AJ. Outdoor air pollution exposure and uterine cancer incidence in the Sister Study. J Natl Cancer Inst 2024; 116:948-956. [PMID: 38346713 PMCID: PMC11160506 DOI: 10.1093/jnci/djae031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/26/2024] [Accepted: 02/07/2024] [Indexed: 03/16/2024] Open
Abstract
BACKGROUND Outdoor air pollution is a ubiquitous exposure that includes endocrine-disrupting and carcinogenic compounds that may contribute to the risk of hormone-sensitive outcomes such as uterine cancer. However, there is limited evidence about the relationship between outdoor air pollution and uterine cancer incidence. METHODS We investigated the associations of residential exposure to particulate matter less than 2.5 µm in aerodynamic diameter (PM2.5) and nitrogen dioxide (NO2) with uterine cancer among 33 417 Sister Study participants with an intact uterus at baseline (2003-2009). Annual average air pollutant concentrations were estimated at participants' geocoded primary residential addresses using validated spatiotemporal models. Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals for the association between time-varying 12-month PM2.5 (µg/m3) and NO2 (parts per billion; ppb) averages and uterine cancer incidence. RESULTS Over a median follow-up period of 9.8 years, 319 incident uterine cancer cases were identified. A 5-ppb increase in NO2 was associated with a 23% higher incidence of uterine cancer (hazard ratio = 1.23, 95% confidence interval = 1.04 to 1.46), especially among participants living in urban areas (hazard ratio = 1.53, 95% confidence interval = 1.13 to 2.07), but PM2.5 was not associated with increased uterine cancer incidence. CONCLUSION In this large US cohort, NO2, a marker of vehicular traffic exposure, was associated with a higher incidence of uterine cancer. These findings expand the scope of health effects associated with air pollution, supporting the need for policy and other interventions designed to reduce air pollutant exposure.
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Affiliation(s)
- Jordyn A Brown
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer L Ish
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Che-Jung Chang
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | | | - Katie M O’Brien
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Rena R Jones
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Joel D Kaufman
- Departments of Environmental & Occupational Health Sciences, Medicine, and Epidemiology, University of Washington, Seattle, WA, USA
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Alexandra J White
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
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2
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Zhang P, Zhou C, Zhao K, Liu C, Liu C, He F, Peng W, Jia X, Mi J. Associations of air pollution and greenness with global burden of breast cancer: an ecological study. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:103921-103931. [PMID: 37697184 DOI: 10.1007/s11356-023-29579-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/25/2023] [Indexed: 09/13/2023]
Abstract
Despite the significance of the associations of air pollution and greenness with the risk of breast cancer, this topic has not been investigated on a global scale. We conducted an ecological study using 7 years of data from 162 countries. Disability-adjusted life years (DALYs) and incidence data were used to represent the breast cancer disease burden. Particulate matter with a diameter < 2.5 μm (PM2.5), ozone (O3), nitrogen dioxide (NO2), and the normalized difference vegetation index (NDVI) were adopted as our exposures. We employed generalized linear mixed models to explore the relationship between air pollution and greenness on breast cancer disease burden. The rate ratio (RR) and its 95% confidence interval (CI) indicate the effect size. There is a positive association between air pollution and the burden of breast cancer disease. Contrarily, per interquartile range increment in NDVI was negatively associated with DALYs and incidence. In terms of air pollutants and breast cancer, NDVI seems to have a significant influence on the relationship between these two conditions. A higher amount of greenness helps to alleviate the negative association of air pollution on breast cancer. PM2.5 and O3 play a mediating role in the relationship between greenness and breast cancer disease burden. In areas with higher levels of greenness, there is a possibility that the inverse association between air pollutants and the burden of breast cancer may be influenced.
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Affiliation(s)
- Peiyao Zhang
- Department of Epidemiology and Statistics, School of Public Health, Bengbu Medical College, No. 2600 Donghai Avenue, Bengbu, 233000, China
| | - Cheng Zhou
- Department of Epidemiology and Statistics, School of Public Health, Bengbu Medical College, No. 2600 Donghai Avenue, Bengbu, 233000, China
| | - Ke Zhao
- Department of Epidemiology and Statistics, School of Public Health, Bengbu Medical College, No. 2600 Donghai Avenue, Bengbu, 233000, China
| | - Chengrong Liu
- Department of Epidemiology and Statistics, School of Public Health, Bengbu Medical College, No. 2600 Donghai Avenue, Bengbu, 233000, China
| | - Chao Liu
- Department of Epidemiology and Statistics, School of Public Health, Bengbu Medical College, No. 2600 Donghai Avenue, Bengbu, 233000, China
| | - Fenfen He
- Department of Epidemiology and Statistics, School of Public Health, Bengbu Medical College, No. 2600 Donghai Avenue, Bengbu, 233000, China
| | - Wenjia Peng
- School of Public Health, Fudan University, Shanghai, China
| | - Xianjie Jia
- Department of Epidemiology and Statistics, School of Public Health, Bengbu Medical College, No. 2600 Donghai Avenue, Bengbu, 233000, China
| | - Jing Mi
- Department of Epidemiology and Statistics, School of Public Health, Bengbu Medical College, No. 2600 Donghai Avenue, Bengbu, 233000, China.
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Smotherman C, Sprague B, Datta S, Braithwaite D, Qin H, Yaghjyan L. Association of air pollution with postmenopausal breast cancer risk in UK Biobank. Breast Cancer Res 2023; 25:83. [PMID: 37443054 PMCID: PMC10339564 DOI: 10.1186/s13058-023-01681-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/25/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND We investigated the association of several air pollution measures with postmenopausal breast cancer (BCa) risk. METHODS This study included 155,235 postmenopausal women (of which 6146 with BCa) from UK Biobank. Cancer diagnoses were ascertained through the linkage to the UK National Health Service Central Registers. Annual exposure averages were available from 2005, 2006, 2007, and 2010 for NO2, from 2007 and 2010 for PM10, and from 2010 for PM2.5, NOX, PM2.5-10 and PM2.5 absorbance. Information on BCa risk factors was collected at baseline. Cox proportional hazards regression was used to evaluate the associations of year-specific and cumulative average exposures with BCa risk, overall and with 2-year exposure lag, while adjusting for BCa risk factors. RESULTS PM10 in 2007 and cumulative average PM10 were positively associated with BCa risk (2007 PM10: Hazard ratio [HR] per 10 µg/m3 = 1.18, 95% CI 1.08, 1.29; cumulative average PM10: HR per 10 µg/m3 = 1.99, 95% CI 1.75, 2.27). Compared to women with low exposure, women with higher 2007 PM10 and cumulative average PM10 had greater BCa risk (4th vs. 1st quartile HR = 1.15, 95% CI 1.07, 1.24, p-trend = 0.001 and HR = 1.35, 95% CI 1.25, 1.44, p-trend < 0.0001, respectively). No significant associations were found for any other exposure measures. In the analysis with 2-year exposure lag, both 2007 PM 10 and cumulative average PM10 were positively associated with BCa risk (4th vs. 1st quartile HR = 1.19, 95% CI 1.10, 1.28 and HR = 1.29, 95% CI 1.19, 1.39, respectively). CONCLUSION Our findings suggest a positive association of 2007 PM10 and cumulative average PM10 with postmenopausal BCa risk.
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Affiliation(s)
- Carmen Smotherman
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA.
| | - Brian Sprague
- Department of Surgery, University of Vermont, Burlington, VT, USA
| | - Susmita Datta
- Department of Biostatistics, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Dejana Braithwaite
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA
| | - Huaizhen Qin
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA
| | - Lusine Yaghjyan
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA
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Ish JL, Abubakar M, Fan S, Jones RR, Niehoff NM, Henry JE, Gierach GL, White AJ. Outdoor air pollution and histologic composition of normal breast tissue. ENVIRONMENT INTERNATIONAL 2023; 176:107984. [PMID: 37224678 PMCID: PMC10247451 DOI: 10.1016/j.envint.2023.107984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/09/2023] [Accepted: 05/16/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Biologic pathways underlying the association between outdoor air pollution and breast cancer risk are poorly understood. Breast tissue composition may reflect cumulative exposure to breast cancer risk factors and has been associated with breast cancer risk among patients with benign breast disease. Herein, we evaluated whether fine particulate matter (PM2.5) was associated with the histologic composition of normal breast tissue. METHODS Machine-learning algorithms were applied to digitized hematoxylin and eosin-stained biopsies of normal breast tissue to quantify the epithelium, stroma, adipose and total tissue area from 3,977 individuals aged 18-75 years from a primarily Midwestern United States population who donated breast tissue samples to the Susan G. Komen Tissue Bank (2009-2019). Annual levels of PM2.5 were assigned to each woman's residential address based on year of tissue donation. We applied predictive k-means to assign participants to clusters with similar PM2.5 chemical composition and used linear regression to examine the cross-sectional associations between a 5-μg/m3 increase in PM2.5 and square root-transformed proportions of epithelium, stroma, adipose, and epithelium-to-stroma proportion [ESP], overall and by PM2.5 cluster. RESULTS Higher residential PM2.5 was associated with lower proportion of breast stromal tissue [β = -0.93, 95% confidence interval: (-1.52, -0.33)], but was not related to the proportion of epithelium [β = -0.11 (-0.34, 0.11)]. Although PM2.5 was not associated with ESP overall [β = 0.24 (-0.16, 0.64)], the association significantly differed by PM2.5 chemical composition (p-interaction = 0.04), with a positive association evident only among an urban, Midwestern cluster with higher concentrations of nitrate (NO3-) and ammonium (NH4+) [β = 0.49 (0.03, 0.95)]. CONCLUSIONS Our findings are consistent with a possible role of PM2.5 in breast cancer etiology and suggest that changes in breast tissue composition may be a potential pathway by which outdoor air pollution impacts breast cancer risk. This study further underscores the importance of considering heterogeneity in PM2.5 composition and its impact on breast carcinogenesis.
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Affiliation(s)
- Jennifer L Ish
- Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, NC, USA.
| | - Mustapha Abubakar
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.
| | - Shaoqi Fan
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.
| | - Rena R Jones
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.
| | - Nicole M Niehoff
- Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, NC, USA.
| | - Jill E Henry
- Biospecimen Collection and Banking Core, Susan G. Komen Tissue Bank at the IU Simon Comprehensive Cancer Center, Indianapolis, IN, USA.
| | - Gretchen L Gierach
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.
| | - Alexandra J White
- Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, NC, USA.
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Poulsen AH, Hvidtfeldt UA, Sørensen M, Pedersen JE, Ketzel M, Brandt J, Geels C, Christensen JH, Raaschou-Nielsen O. Air pollution with NO 2, PM 2.5, and elemental carbon in relation to risk of breast cancer- a nationwide case-control study from Denmark. ENVIRONMENTAL RESEARCH 2023; 216:114740. [PMID: 36356668 DOI: 10.1016/j.envres.2022.114740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 10/12/2022] [Accepted: 11/03/2022] [Indexed: 06/16/2023]
Abstract
UNLABELLED Air pollution with particulate matter is an established lung carcinogen. Studies have suggested an association with breast cancer, but the evidence is inconsistent. METHODS From nationwide registers, we identified all breast cancer cases (n = 55 745) in Denmark between 2000 and 2014. We matched one control for each case on age and year of birth. We used a multi-scale dispersion model to estimate outdoor concentrations of particulate matter <2.5 μm (PM2.5), elemental carbon (EC) and nitrogen dioxide (NO2) as time-weighted average over all addresses up to 20 years prior to diagnosis. We calculated odds ratios (OR) and 95% confidence intervals (CI) by conditional logistic regression with adjustment for marital status, educational level, occupational status, personal income, region of origin, medication and area-level socio-economic indicators. RESULTS A 10 μg/m3 higher PM2.5 was associated with an OR for breast cancer of 1.21 (95% CI: 1.11-1.33). The corresponding ORs for EC (per 1 μg/m3) and NO2 (per 10 μg/m3) were 1.03 (95% CI: 1.00-1.07) and 1.03 (95% CI: 1.01-1.06), respectively. In multi-pollutant models, the OR for PM2.5 changed only little, whereas ORs for EC or NO2 approached the null. In an analysis of persons below 55 years, PM2.5 was associated with an OR of 1.32 (95% CI: 1.09-1.60) per 10 μg/m3 increase. CONCLUSION We found evidence of an association between the investigated air pollutants and breast cancer, especially PM2.5. There were indications that the association differed by age at diagnosis. We were not able to include all potential confounders and thus, results should be interpreted with caution.
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Affiliation(s)
| | | | - Mette Sørensen
- Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Natural Science and Environment, Roskilde University, Roskilde, Denmark
| | | | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; Global Centre for Clean Air Research (GCARE), Department of Civil and Environmental Engineering, University of Surrey, Guildford, United Kingdom
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Camilla Geels
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | | | - Ole Raaschou-Nielsen
- Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Environmental Science, Aarhus University, Roskilde, Denmark
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6
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Exposure to natural vegetation in relation to mammographic density in a Massachusetts-based clinical cohort. Environ Epidemiol 2022; 6:e216. [PMID: 35975164 PMCID: PMC9374192 DOI: 10.1097/ee9.0000000000000216] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 06/14/2022] [Indexed: 11/26/2022] Open
Abstract
Inverse associations between natural vegetation exposure (i.e., greenness) and breast cancer risk have been reported; however, it remains unknown whether greenness affects breast tissue development or operates through other mechanisms (e.g., body mass index [BMI] or physical activity). We examined the association between greenness and mammographic density—a strong breast cancer risk factor—to determine whether greenness influences breast tissue composition independent of lifestyle factors.
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Jiménez T, Pollán M, Domínguez-Castillo A, Lucas P, Sierra MÁ, Fernández de Larrea-Baz N, González-Sánchez M, Salas-Trejo D, Llobet R, Martínez I, Pino MN, Martínez-Cortés M, Pérez-Gómez B, Lope V, García-Pérez J. Residential proximity to industrial pollution and mammographic density. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 829:154578. [PMID: 35304152 DOI: 10.1016/j.scitotenv.2022.154578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/25/2022] [Accepted: 03/11/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Mammographic density (MD), expressed as percentage of fibroglandular breast tissue, is an important risk factor for breast cancer. Our objective is to investigate the relationship between MD and residential proximity to pollutant industries in premenopausal Spanish women. METHODS A cross-sectional study was carried out in a sample of 1225 women extracted from the DDM-Madrid study. Multiple linear regression models were used to assess the association of MD percentage (and their 95% confidence intervals (95%CIs)) and proximity (between 1 km and 3 km) to industries included in the European Pollutant Release and Transfer Register. RESULTS Although no association was found between MD and distance to all industries as a whole, several industrial sectors showed significant association for some distances: "surface treatment of metals and plastic" (β = 4.98, 95%CI = (0.85; 9.12) at ≤1.5 km, and β = 3.00, 95%CI = (0.26; 5.73) at ≤2.5 km), "organic chemical industry" (β = 6.73, 95%CI = (0.50; 12.97) at ≤1.5 km), "pharmaceutical products" (β = 4.14, 95%CI = (0.58; 7.70) at ≤2 km; β = 3.55, 95%CI = (0.49; 6.60) at ≤2.5 km; and β = 3.11, 95%CI = (0.20; 6.01) at ≤3 km), and "urban waste-water treatment plants" (β = 8.06, 95%CI = (0.82; 15.30) at ≤1 km; β = 5.28; 95%CI = (0.49; 10.06) at ≤1.5 km; β = 4.30, 95%CI = (0.03; 8.57) at ≤2 km; β = 5.26, 95%CI = (1.83; 8.68) at ≤2.5 km; and β = 3.19, 95%CI = (0.46; 5.92) at ≤3 km). Moreover, significant increased MD was observed in women close to industries releasing specific pollutants: ammonia (β = 4.55, 95%CI = (0.26; 8.83) at ≤1.5 km; and β = 3.81, 95%CI = (0.49; 7.14) at ≤2 km), dichloromethane (β = 3.86, 95%CI = (0.00; 7.71) at ≤2 km), ethylbenzene (β = 8.96, 95%CI = (0.57; 17.35) at ≤3 km), and phenols (β = 2.60, 95%CI = (0.21; 5.00) at ≤2.5 km). CONCLUSIONS Our results suggest no statistically significant relationship between MD and proximity to industries as a whole, although we detected associations with various industrial sectors and some specific pollutants, which suggests that MD could have a mediating role in breast carcinogenesis.
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Affiliation(s)
- Tamara Jiménez
- Department of Preventive Medicine, Public Health and Microbiology, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Marina Pollán
- Cancer and Environmental Epidemiology Unit, Department of Epidemiology of Chronic Diseases, National Center for Epidemiology, Instituto de Salud Carlos III (Carlos III Institute of Health), Madrid, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Spain.
| | - Alejandro Domínguez-Castillo
- Cancer and Environmental Epidemiology Unit, Department of Epidemiology of Chronic Diseases, National Center for Epidemiology, Instituto de Salud Carlos III (Carlos III Institute of Health), Madrid, Spain.
| | - Pilar Lucas
- Cancer and Environmental Epidemiology Unit, Department of Epidemiology of Chronic Diseases, National Center for Epidemiology, Instituto de Salud Carlos III (Carlos III Institute of Health), Madrid, Spain.
| | - María Ángeles Sierra
- Cancer and Environmental Epidemiology Unit, Department of Epidemiology of Chronic Diseases, National Center for Epidemiology, Instituto de Salud Carlos III (Carlos III Institute of Health), Madrid, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Spain.
| | - Nerea Fernández de Larrea-Baz
- Cancer and Environmental Epidemiology Unit, Department of Epidemiology of Chronic Diseases, National Center for Epidemiology, Instituto de Salud Carlos III (Carlos III Institute of Health), Madrid, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Spain.
| | - Mario González-Sánchez
- Cancer and Environmental Epidemiology Unit, Department of Epidemiology of Chronic Diseases, National Center for Epidemiology, Instituto de Salud Carlos III (Carlos III Institute of Health), Madrid, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Spain.
| | - Dolores Salas-Trejo
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Spain; Valencian Breast Cancer Screening Program, General Directorate of Public Health, Valencia, Spain; Center for Public Health Research CSISP, FISABIO, Valencia, Spain.
| | - Rafael Llobet
- Institute of Computer Technology, Universitat Politècnica de València, Valencia, Spain.
| | - Inmaculada Martínez
- Valencian Breast Cancer Screening Program, General Directorate of Public Health, Valencia, Spain; Center for Public Health Research CSISP, FISABIO, Valencia, Spain.
| | - Marina Nieves Pino
- Servicio de Prevención y Promoción de la Salud, Madrid Salud, Ayuntamiento de Madrid, Madrid, Spain.
| | - Mercedes Martínez-Cortés
- Servicio de Prevención y Promoción de la Salud, Madrid Salud, Ayuntamiento de Madrid, Madrid, Spain.
| | - Beatriz Pérez-Gómez
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Spain; Department of Epidemiology of Chronic Diseases, National Center for Epidemiology, Instituto de Salud Carlos III (Carlos III Institute of Health), Madrid, Spain.
| | - Virginia Lope
- Cancer and Environmental Epidemiology Unit, Department of Epidemiology of Chronic Diseases, National Center for Epidemiology, Instituto de Salud Carlos III (Carlos III Institute of Health), Madrid, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Spain.
| | - Javier García-Pérez
- Cancer and Environmental Epidemiology Unit, Department of Epidemiology of Chronic Diseases, National Center for Epidemiology, Instituto de Salud Carlos III (Carlos III Institute of Health), Madrid, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Spain.
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Eslami B, Alipour S, Omranipour R, Naddafi K, Naghizadeh MM, Shamsipour M, Aryan A, Abedi M, Bayani L, Hassanvand MS. Air pollution exposure and mammographic breast density in Tehran, Iran: a cross-sectional study. Environ Health Prev Med 2022; 27:28. [PMID: 35786683 PMCID: PMC9283909 DOI: 10.1265/ehpm.22-00027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Air pollution is one of the major public health challenges in many parts of the world possibly has an association with breast cancer. However, the mechanism is still unclear. This study aimed to find an association between exposure to six criteria ambient air pollutants (PM2.5, PM10, SO2, NO2, O3, and CO) and mammographic breast density (MBD), as one of the strongest predictors for developing breast cancer, in women living in Tehran, Iran. METHODS Participants were selected from women attending two university hospitals for screening mammography from 2019 to 2021. Breast density was rated by two expert radiologists. Individual exposures to 3-year ambient air pollution levels at the residence were estimated. RESULTS The final analysis in 791 eligible women showed that low and high breast density was detected in 34.8 and 62.2 of participants, respectively. Logistic regression analysis after considering all possible confounding factors represented that an increase in each unit of NO2 (ppb) exposure was associated with an increased risk of breast density with an OR equal to 1.04 (95CI: 1.01 to 1.07). Furthermore, CO level was associated with a decreasing breast density (OR = 0.40, 95CI = 0.19 to 0.86). None of the other pollutants were associated with breast density. CONCLUSION Higher MBD was associated with an increased level of NO2, as a marker of traffic-related air pollution. Furthermore, CO concentration was associated with a lower MBD, while other criteria air pollutants were not related to MBD. Further studies are needed to evaluate the association between ambient air pollutants with MBD.
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Affiliation(s)
- Bita Eslami
- Breast Diseases Research Center, Cancer Institute, Tehran University of Medical Science
| | - Sadaf Alipour
- Breast Diseases Research Center, Cancer Institute, Tehran University of Medical Science.,Department of Surgery, Arash Women's Hospital, Tehran University of Medical Sciences
| | - Ramesh Omranipour
- Breast Diseases Research Center, Cancer Institute, Tehran University of Medical Science.,Department of Surgical Oncology, Cancer Institute, Tehran University of Medical Sciences
| | - Kazem Naddafi
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences.,Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences
| | | | - Mansour Shamsipour
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences.,Department of Research Methodology and Data Analysis, Institute for Environmental Research (IER), Tehran University of Medical Sciences
| | - Arvin Aryan
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences
| | - Mahboubeh Abedi
- Department of Radiology, Arash Women's Hospital, Tehran University of Medical Sciences
| | - Leila Bayani
- Department of Radiology, Arash Women's Hospital, Tehran University of Medical Sciences
| | - Mohammad Sadegh Hassanvand
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences.,Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences
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9
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Kehm RD, Walter EJ, Oskar S, White ML, Tehranifar P, Herbstman JB, Perera F, Lilge L, Miller RL, Terry MB. Exposure to polycyclic aromatic hydrocarbons during pregnancy and breast tissue composition in adolescent daughters and their mothers: a prospective cohort study. Breast Cancer Res 2022; 24:47. [PMID: 35821060 PMCID: PMC9277813 DOI: 10.1186/s13058-022-01546-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 07/01/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Polycyclic aromatic hydrocarbons (PAH), which are found in air pollution, have carcinogenic and endocrine disrupting properties that might increase breast cancer risk. PAH exposure might be particularly detrimental during pregnancy, as this is a time when the breast tissue of both the mother and daughter is undergoing structural and functional changes. In this study, we tested the hypothesis that ambient PAH exposure during pregnancy is associated with breast tissue composition, measured one to two decades later, in adolescent daughters and their mothers. METHODS We conducted a prospective analysis using data from a New York City cohort of non-Hispanic Black and Hispanic mother-daughter dyads (recruited 1998-2006). During the third trimester of pregnancy, women wore backpacks containing a continuously operating air sampling pump for two consecutive days that measured ambient exposure to eight carcinogenic higher molecular weight nonvolatile PAH compounds (Σ8 PAH) and pyrene. When daughters (n = 186) and mothers (n = 175) reached ages 11-20 and 29-55 years, respectively, optical spectroscopy (OS) was used to evaluate measures of breast tissue composition (BTC) that positively (water content, collagen content, optical index) and negatively (lipid content) correlate with mammographic breast density, a recognized risk factor for breast cancer. Multivariable linear regression was used to evaluate associations between ambient PAH exposure and BTC, overall and by exposure to household tobacco smoke during pregnancy (yes/no). Models were adjusted for race/ethnicity, age, and percent body fat at OS. RESULTS No overall associations were found between ambient PAH exposure (Σ8 PAH or pyrene) and BTC, but statistically significant additive interactions between Σ8 PAH and household tobacco smoke exposure were identified for water content and optical index in both daughters and mothers (interaction p values < 0.05). Σ8 PAH exposure was associated with higher water content (βdaughters = 0.42, 95% CI = 0.15-0.68; βmothers = 0.32, 95% CI = 0.05-0.61) and higher optical index (βdaughters = 0.38, 95% CI = 0.12-0.64; βmothers = 0.38, 95% CI = 0.12-0.65) in those exposed to household tobacco smoke during pregnancy; no associations were found in non-smoking households (interaction p values < 0.05). CONCLUSIONS Exposure to ambient Σ8 PAH and tobacco smoke during pregnancy might interact synergistically to impact BTC in mothers and daughters. If replicated in other cohorts, these findings might have important implications for breast cancer risk across generations.
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Affiliation(s)
- Rebecca D. Kehm
- grid.21729.3f0000000419368729Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, Room 1605, New York, NY 10032 USA
| | - E. Jane Walter
- grid.231844.80000 0004 0474 0428Princess Margaret Cancer Centre, University Health Network, 101 College St, Toronto, ON M5G 0A3 Canada
| | - Sabine Oskar
- grid.21729.3f0000000419368729Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, Room 1605, New York, NY 10032 USA
| | - Melissa L. White
- grid.21729.3f0000000419368729Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, Room 1605, New York, NY 10032 USA
| | - Parisa Tehranifar
- grid.21729.3f0000000419368729Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, Room 1605, New York, NY 10032 USA ,grid.239585.00000 0001 2285 2675Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY 10032 USA
| | - Julie B. Herbstman
- grid.21729.3f0000000419368729Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032 USA
| | - Frederica Perera
- grid.21729.3f0000000419368729Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032 USA
| | - Lothar Lilge
- grid.231844.80000 0004 0474 0428Princess Margaret Cancer Centre, University Health Network, 101 College St, Toronto, ON M5G 0A3 Canada ,grid.17063.330000 0001 2157 2938Department of Medical Biophysics, University of Toronto, 101 College St, Toronto, ON M5G 0A3 Canada
| | - Rachel L. Miller
- grid.59734.3c0000 0001 0670 2351Division of Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, New York, NY 10029 USA
| | - Mary Beth Terry
- grid.21729.3f0000000419368729Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, Room 1605, New York, NY 10032 USA ,grid.239585.00000 0001 2285 2675Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY 10032 USA
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10
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Lemarchand C, Gabet S, Cénée S, Tvardik N, Slama R, Guénel P. Breast cancer risk in relation to ambient concentrations of nitrogen dioxide and particulate matter: results of a population-based case-control study corrected for potential selection bias (the CECILE study). ENVIRONMENT INTERNATIONAL 2021; 155:106604. [PMID: 34030067 DOI: 10.1016/j.envint.2021.106604] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/20/2021] [Accepted: 04/24/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND There is only scant evidence that air pollution increases the risk of breast cancer. OBJECTIVES We investigated this relationship for three air pollutants: nitrogen dioxide (NO2) and particulate matter with an aerodynamical diameter below 10 µm (PM10) and 2.5 µm (PM2.5). METHODS We conducted a population-based case-control study on breast cancer in two French départements, including 1,229 women diagnosed with breast cancer in 2005-2007 and 1,316 control women frequency-matched on age. Concentrations of NO2, PM10 and PM2.5 at participants' addresses occupied during the last 10 years were assessed using a chemistry transport model. Odds ratios (OR) and 95% confidence intervals (95% CI) were estimated using multivariable logistic regression models where each woman was assigned a weight depending on her probability of selection into the study. RESULTS The OR for breast cancer per 10-µg/m3 increase in NO2 was 1.11 (95% CI, 0.98, 1.26), and 1.41 (95% CI 1.07, 1.86) in the highest exposure quintile (Q5), compared to the first. The ORs per 10-µg/m3 NO2 did not markedly differ between pre- (OR 1.09, 95% CI 0.89, 1.35)) and post-menopausal women (OR 1.14, 95% CI 0.97, 1.33)), but the OR was substantially higher for hormone-receptor positive (ER+/PR+) breast tumor subtypes (OR 1.15, 95% CI 1.00, 1.31) than for ER-/PR- tumors (OR 0.95, 95% CI 0.72, 1.26). Breast cancer risk was not associated with either PM10 (OR per 1 µg/m3 1.01, 95% CI, 0.96, 1.06) or PM2.5 (OR per 1 µg/m3 1.02, 95% CI 0.95, 1.08), regardless of the menopausal status or of the breast tumor subtype. DISCUSSION Our study provides evidence that NO2 exposure, a marker of traffic-related air pollutants, may be associated with an increased risk of breast cancer, particularly ER+/PR+ tumors.
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Affiliation(s)
- Clémentine Lemarchand
- University Paris-Saclay, UVSQ, Gustave Roussy, Inserm, CESP, Team Exposome and Heredity, 94800 Villejuif, France
| | - Stephan Gabet
- Univ. Grenoble Alpes, Inserm, CNRS, Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, IAB, 38000 Grenoble, France
| | - Sylvie Cénée
- University Paris-Saclay, UVSQ, Gustave Roussy, Inserm, CESP, Team Exposome and Heredity, 94800 Villejuif, France
| | - Nastassia Tvardik
- University Paris-Saclay, UVSQ, Gustave Roussy, Inserm, CESP, Team Exposome and Heredity, 94800 Villejuif, France
| | - Rémy Slama
- Univ. Grenoble Alpes, Inserm, CNRS, Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, IAB, 38000 Grenoble, France
| | - Pascal Guénel
- University Paris-Saclay, UVSQ, Gustave Roussy, Inserm, CESP, Team Exposome and Heredity, 94800 Villejuif, France.
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11
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Yu Q, Zhang L, Hou K, Li J, Liu S, Huang K, Cheng Y. Relationship between Air Pollutant Exposure and Gynecologic Cancer Risk. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5353. [PMID: 34069801 PMCID: PMC8157305 DOI: 10.3390/ijerph18105353] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 11/16/2022]
Abstract
Exposure to air pollution has been suggested to be associated with an increased risk of women's health disorders. However, it remains unknown to what extent changes in ambient air pollution affect gynecological cancer. In our case-control study, the logistic regression model was combined with the restricted cubic spline to examine the association of short-term exposure to air pollution with gynecological cancer events using the clinical data of 35,989 women in Beijing from December 2008 to December 2017. We assessed the women's exposure to air pollutants using the monitor located nearest to each woman's residence and working places, adjusting for age, occupation, ambient temperature, and ambient humidity. The adjusted odds ratios (ORs) were examined to evaluate gynecologic cancer risk in six time windows (Phase 1-Phase 6) of women's exposure to air pollutants (PM2.5, CO, O3, and SO2) and the highest ORs were found in Phase 4 (240 days). Then, the higher adjusted ORs were found associated with the increased concentrations of each pollutant (PM2.5, CO, O3, and SO2) in Phase 4. For instance, the adjusted OR of gynecological cancer risk for a 1.0-mg m-3 increase in CO exposures was 1.010 (95% CI: 0.881-1.139) below 0.8 mg m-3, 1.032 (95% CI: 0.871-1.194) at 0.8-1.0 mg m-3, 1.059 (95% CI: 0.973-1.145) at 1.0-1.4 mg m-3, and 1.120 (95% CI: 0.993-1.246) above 1.4 mg m-3. The ORs calculated in different air pollution levels accessed us to identify the nonlinear association between women's exposure to air pollutants (PM2.5, CO, O3, and SO2) and the gynecological cancer risk. This study supports that the gynecologic risks associated with air pollution should be considered in improved public health preventive measures and policymaking to minimize the dangerous effects of air pollution.
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Affiliation(s)
- Qiwei Yu
- State Key Laboratory of Remote Sensing Science, Faculty of Geographical Science, Beijing Normal University, Beijing 100875, China; (Q.Y.); (K.H.); (S.L.); (K.H.); (Y.C.)
| | - Liqiang Zhang
- State Key Laboratory of Remote Sensing Science, Faculty of Geographical Science, Beijing Normal University, Beijing 100875, China; (Q.Y.); (K.H.); (S.L.); (K.H.); (Y.C.)
- Guangxi Key Laboratory of Spatial Information and Geomatics, Guilin University of Technology, Guilin 541004, China;
| | - Kun Hou
- State Key Laboratory of Remote Sensing Science, Faculty of Geographical Science, Beijing Normal University, Beijing 100875, China; (Q.Y.); (K.H.); (S.L.); (K.H.); (Y.C.)
| | - Jingwen Li
- Guangxi Key Laboratory of Spatial Information and Geomatics, Guilin University of Technology, Guilin 541004, China;
| | - Suhong Liu
- State Key Laboratory of Remote Sensing Science, Faculty of Geographical Science, Beijing Normal University, Beijing 100875, China; (Q.Y.); (K.H.); (S.L.); (K.H.); (Y.C.)
| | - Ke Huang
- State Key Laboratory of Remote Sensing Science, Faculty of Geographical Science, Beijing Normal University, Beijing 100875, China; (Q.Y.); (K.H.); (S.L.); (K.H.); (Y.C.)
| | - Yang Cheng
- State Key Laboratory of Remote Sensing Science, Faculty of Geographical Science, Beijing Normal University, Beijing 100875, China; (Q.Y.); (K.H.); (S.L.); (K.H.); (Y.C.)
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12
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Gabet S, Lemarchand C, Guénel P, Slama R. Breast Cancer Risk in Association with Atmospheric Pollution Exposure: A Meta-Analysis of Effect Estimates Followed by a Health Impact Assessment. ENVIRONMENTAL HEALTH PERSPECTIVES 2021; 129:57012. [PMID: 34038220 PMCID: PMC8153692 DOI: 10.1289/ehp8419] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 03/08/2021] [Accepted: 05/04/2021] [Indexed: 05/25/2023]
Abstract
BACKGROUND The epidemiological literature of associations between atmospheric pollutant exposure and breast cancer incidence has recently strongly evolved. OBJECTIVES We aimed to perform a) a meta-analysis of studies considering this relationship, correcting for publication bias and taking menopausal status and cancer hormone responsiveness into account; and b) for the pollutants most likely to affect breast cancer, an assessment of the corresponding number of attributable cases in France and of the related economic costs. METHODS We conducted a literature review and random-effects meta-analyses of epidemiological studies examining the association of fine particulate matter with aerodynamic diameter less than or equal to 2.5μm (PM2.5), particulate matter with aerodynamic diameter less than or equal to 10 μm (PM10), and NO2 long-term exposure with breast cancer incidence; additional analyses were stratified on menopausal status and on tumor hormone responsiveness status. The resulting dose-response functions were combined with modeled atmospheric pollutant exposures in 2013 for France, cancer treatments costs, lost productivity, and years of life lost, to estimate the number of breast cancers attributable to atmospheric pollution and related economic costs in France. RESULTS The review identified 32, 27, and 36 effect estimates for PM2.5, PM10, and NO2, respectively. The meta-analytical relative risk estimates of breast cancer corrected for publication bias were 1.006 [95% confidence interval (CI): 0.941, 1.076], 1.047 (95% CI: 0.984, 1.113), and 1.023 (95% CI: 1.005, 1.041), respectively. NO2 estimated effects appeared higher in premenopausal than in postmenopausal women and higher for hormone responsive positive (ER+/PR+) than negative (ER-/PR-) breast cancers. Assuming a causal effect of NO2, we estimated that 1,677 (95% CI: 374, 2,914) new breast cancer cases were attributable to NO2 annually in France, or 3.15% (95% CI: 0.70, 5.48) of the incident cases. The corresponding tangible and intangible costs were estimated to be €825 million (low, high: 570, 1,080) per year. CONCLUSION These findings suggest that decreasing long-term NO2 exposure or correlated air pollutant exposures could lower breast cancer risk. https://doi.org/10.1289/EHP8419.
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Affiliation(s)
- Stephan Gabet
- Institut national de la santé et de la recherche médicale (Inserm), Le Centre national de la recherche scientifique (CNRS), Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, IAB, Université Grenoble Alpes, Grenoble, France
| | - Clémentine Lemarchand
- Inserm, Exposome and Heredity, Centre de recherche en Épidémiologie et Santé des Populations (CESP), Université Paris-Saclay, Villejuif, France
| | - Pascal Guénel
- Inserm, Exposome and Heredity, Centre de recherche en Épidémiologie et Santé des Populations (CESP), Université Paris-Saclay, Villejuif, France
| | - Rémy Slama
- Institut national de la santé et de la recherche médicale (Inserm), Le Centre national de la recherche scientifique (CNRS), Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, IAB, Université Grenoble Alpes, Grenoble, France
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13
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Zenteno JS, Rosende PF, Manzur BC, Vega IS. Breast cancer incidence and the air pollution level in the communes of Chile: an ecological study. Ecancermedicalscience 2021; 15:1191. [PMID: 33889200 PMCID: PMC8043680 DOI: 10.3332/ecancer.2021.1191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Indexed: 12/24/2022] Open
Abstract
There is evidence linking air pollutants associated with vehicular traffic such as polycyclic aromatic hydrocarbons with breast carcinogenesis. Epidemiological studies have shown conflicting results regarding air pollution and breast cancer risk, which could be explained by the multitude of other risk factors that could affect the association. In Chile, air pollution has reached alarming levels, either due to motorised vehicle traffic or the combustion of wood for heating; therefore, our objective was to evaluate the association between the incidence of breast cancer and the concentration of the main air pollutants monitored in the country. We carried out a cross-sectional ecological study that evaluated the association between the average incidence of breast cancer in years (2016 to 2018) and the average annual concentration of six atmospheric pollutants in the 5 years prior to the estimation of the rate in communes of Chile, using the population of beneficiaries of Instituto Oncológico Fundación Arturo López Pérez. The annual incidence of breast cancer was 72.21 cases per 100,000 women and it varied significantly in the communes studied compared to the human development index (HDI) and to the proportion of women in the age group at highest risk. Assessing the relationship between the incidence of breast cancer and the average concentration of atmospheric pollutants, we only found a direct correlation between the level of nitrogen dioxide and the rate (R = 0.82; p = 0.044), whose significance tends to be lost when age and the communal HDI are included in a regression model.
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Affiliation(s)
- Jorge Sapunar Zenteno
- Epidemiology Research Unit, Research Department, Instituto Oncológico Fundación Arturo López Pérez, Cano y Aponte 927, Providencia, Santiago 7500000, Chile.,EPICYN Center, Department of Internal Medicine, Facultad de Medicina, Universidad de La Frontera, Temuco 4780000, Chile.,Breast Oncology Surgery Unit, Instituto Oncológico Fundación Arturo López Pérez, Santiago 7500000, Chile
| | - Pedro Ferrer Rosende
- Epidemiology Research Unit, Research Department, Instituto Oncológico Fundación Arturo López Pérez, Cano y Aponte 927, Providencia, Santiago 7500000, Chile
| | - Badir Chahuán Manzur
- Breast Oncology Surgery Unit, Instituto Oncológico Fundación Arturo López Pérez, Santiago 7500000, Chile
| | - Isabel Saffie Vega
- Breast Oncology Surgery Unit, Instituto Oncológico Fundación Arturo López Pérez, Santiago 7500000, Chile
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14
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Turner MC, Andersen ZJ, Baccarelli A, Diver WR, Gapstur SM, Pope CA, Prada D, Samet J, Thurston G, Cohen A. Outdoor air pollution and cancer: An overview of the current evidence and public health recommendations. CA Cancer J Clin 2020; 70:10.3322/caac.21632. [PMID: 32964460 PMCID: PMC7904962 DOI: 10.3322/caac.21632] [Citation(s) in RCA: 271] [Impact Index Per Article: 67.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 12/24/2022] Open
Abstract
Outdoor air pollution is a major contributor to the burden of disease worldwide. Most of the global population resides in places where air pollution levels, because of emissions from industry, power generation, transportation, and domestic burning, considerably exceed the World Health Organization's health-based air-quality guidelines. Outdoor air pollution poses an urgent worldwide public health challenge because it is ubiquitous and has numerous serious adverse human health effects, including cancer. Currently, there is substantial evidence from studies of humans and experimental animals as well as mechanistic evidence to support a causal link between outdoor (ambient) air pollution, and especially particulate matter (PM) in outdoor air, with lung cancer incidence and mortality. It is estimated that hundreds of thousands of lung cancer deaths annually worldwide are attributable to PM air pollution. Epidemiological evidence on outdoor air pollution and the risk of other types of cancer, such as bladder cancer or breast cancer, is more limited. Outdoor air pollution may also be associated with poorer cancer survival, although further research is needed. This report presents an overview of outdoor air pollutants, sources, and global levels, as well as a description of epidemiological evidence linking outdoor air pollution with cancer incidence and mortality. Biological mechanisms of air pollution-derived carcinogenesis are also described. This report concludes by summarizing public health/policy recommendations, including multilevel interventions aimed at individual, community, and regional scales. Specific roles for medical and health care communities with regard to prevention and advocacy and recommendations for further research are also described.
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Affiliation(s)
- Michelle C. Turner
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, Ontario, Canada
| | - Zorana J. Andersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Andrea Baccarelli
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, United States
| | - W. Ryan Diver
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, Georgia, United States
| | - Susan M. Gapstur
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, Georgia, United States
| | - C. Arden Pope
- Department of Economics, Brigham Young University, Provo, Utah, United States
| | - Diddier Prada
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, United States
- Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Jonathan Samet
- Colorado School of Public Health, Aurora, Colorado, United States
| | - George Thurston
- New York University School of Medicine, New York, New York, United States
| | - Aaron Cohen
- Health Effects Institute, Boston, Massachusetts, United States
- Institute for Health Metrics and Evaluation, Seattle, Washington, United States
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15
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Lian J, Li K. A Review of Breast Density Implications and Breast Cancer Screening. Clin Breast Cancer 2020; 20:283-290. [DOI: 10.1016/j.clbc.2020.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/10/2020] [Accepted: 03/12/2020] [Indexed: 12/15/2022]
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16
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DuPré NC, Heng YJ, Raby BA, Glass K, Hart JE, Chu JH, Askew C, Eliassen AH, Hankinson SE, Kraft P, Laden F, Tamimi RM. Involvement of fine particulate matter exposure with gene expression pathways in breast tumor and adjacent-normal breast tissue. ENVIRONMENTAL RESEARCH 2020; 186:109535. [PMID: 32668536 PMCID: PMC7368092 DOI: 10.1016/j.envres.2020.109535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/18/2020] [Accepted: 04/12/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Fine particulate matter (PM2.5) has been associated with breast cancer specific mortality, particularly for women with Stage I cancer. We examined the biological pathways that are perturbed by PM2.5 exposures by analyzing gene expression measurements from breast tissue specimens. METHODS The Nurses' Health Studies (NHS and NHSII) are prospective cohorts with archival breast tissue specimens from breast cancer cases. Global gene expression data were ascertained with the Affymetrix Glue Human Transcriptome Array 3.0. PM2.5 was estimated using spatio-temporal models linked to participants' home addresses. All analyses were performed separately in tumor (n = 591) and adjacent-normal (n = 497) samples, and stratified by estrogen receptor (ER) status and stage. We used multivariable linear regression, gene-set enrichment analyses (GSEA), and the least squares kernel machine (LSKM) to assess whether 3-year cumulative average pre-diagnosis PM2.5 exposure was associated with breast-tissue gene expression pathways among predominately Stage I and II women (90.7%) and postmenopausal (81.2%) women. Replication samples (tumor, n = 245; adjacent-normal, n = 165) were measured on Affymetrix Human Transcriptome Array (HTA 2.0). RESULTS Overall, no pathways in the tumor area were significantly associated with PM2.5 exposure. Among 272 adjacent-normal samples from Stage I ER-positive women, PM2.5 was associated with perturbations in the oxidative phosphorylation, protein secretion, and mTORC1 signaling pathways (GSEA and LSKM p-values <0.05); however, results were not replicated in a small set of replication samples (n = 80). CONCLUSIONS PM2.5 was generally not associated with breast tissue gene expression though was suggested to perturb oxidative phosphorylation and regulation of proteins and cellular signaling in adjacent-normal breast tissue. More research is needed on the biological role of PM2.5 that influences breast tumor progression.
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Affiliation(s)
- Natalie C DuPré
- Channing Division of Network Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology and Population Health, University of Louisville School of Public Health and Information Sciences, Louisville, KY, USA.
| | - Yujing J Heng
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Cancer Research Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Benjamin A Raby
- Channing Division of Network Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kimberly Glass
- Channing Division of Network Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, 02215, USA
| | - Jaime E Hart
- Channing Division of Network Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jen-Hwa Chu
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Catherine Askew
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - A Heather Eliassen
- Channing Division of Network Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Susan E Hankinson
- Channing Division of Network Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Peter Kraft
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, 02215, USA
| | - Francine Laden
- Channing Division of Network Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Rulla M Tamimi
- Channing Division of Network Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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17
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Hwang J, Bae H, Choi S, Yi H, Ko B, Kim N. Impact of air pollution on breast cancer incidence and mortality: a nationwide analysis in South Korea. Sci Rep 2020; 10:5392. [PMID: 32214155 PMCID: PMC7096411 DOI: 10.1038/s41598-020-62200-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 03/09/2020] [Indexed: 11/18/2022] Open
Abstract
Breast cancer is one of the major female health problems worldwide. Although there is growing evidence indicating that air pollution increases the risk of breast cancer, there is still inconsistency among previous studies. Unlike the previous studies those had case-control or cohort study designs, we performed a nationwide, whole-population census study. In all 252 administrative districts in South Korea, the associations between ambient NO2 and particulate matter 10 (PM10) concentration, and age-adjusted breast cancer mortality rate in females (from 2005 to 2016, Nmortality = 23,565), and incidence rate (from 2004 to 2013, Nincidence = 133,373) were investigated via multivariable beta regression. Population density, altitude, rate of higher education, smoking rate, obesity rate, parity, unemployment rate, breastfeeding rate, oral contraceptive usage rate, and Gross Regional Domestic Product per capita were considered as potential confounders. Ambient air pollutant concentrations were positively and significantly associated with the breast cancer incidence rate: per 100 ppb CO increase, Odds Ratio OR = 1.08 (95% Confidence Interval CI = 1.06-1.10), per 10 ppb NO2, OR = 1.14 (95% CI = 1.12-1.16), per 1 ppb SO2, OR = 1.04 (95% CI = 1.02-1.05), per 10 µg/m3 PM10, OR = 1.13 (95% CI = 1.09-1.17). However, no significant association between the air pollutants and the breast cancer mortality rate was observed except for PM10: per 10 µg/m3 PM10, OR = 1.05 (95% CI = 1.01-1.09).
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Affiliation(s)
- Jeongeun Hwang
- Department of Medicine, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyunjin Bae
- Department of Medicine, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seunghyun Choi
- Department of Convergence Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Hahn Yi
- Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea
| | - Beomseok Ko
- Department of Breast Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
| | - Namkug Kim
- Department of Convergence Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
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18
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Lynge E, Vejborg I, Andersen Z, von Euler-Chelpin M, Napolitano G. Mammographic Density and Screening Sensitivity, Breast Cancer Incidence and Associated Risk Factors in Danish Breast Cancer Screening. J Clin Med 2019; 8:jcm8112021. [PMID: 31752353 PMCID: PMC6912479 DOI: 10.3390/jcm8112021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 11/11/2019] [Accepted: 11/14/2019] [Indexed: 01/30/2023] Open
Abstract
Background: Attention in the 2000s on the importance of mammographic density led us to study screening sensitivity, breast cancer incidence, and associations with risk factors by mammographic density in Danish breast cancer screening programs. Here, we summarise our approaches and findings. Methods: Dichotomized density codes: fatty, equal to BI-RADS density code 1 and part of 2, and other mixed/dense data from the 1990s—were available from two counties, and BI-RADS density codes from one region were available from 2012/13. Density data were linked with data on vital status, incident breast cancer, and potential risk factors. We calculated screening sensitivity by combining data on screen-detected and interval cancers. We used cohorts to study high density as a predictor of breast cancer risk; cross-sectional data to study the association between life style factors and density, adjusting for age and body mass index (BMI); and time trends to study the prevalence of high density across birth cohorts. Results: Sensitivity decreased with increasing density from 78% in women with BI-RADS 1 to 47% in those with BI-RADS 4. For women with mixed/dense compared with those with fatty breasts, the rate ratio of incident breast cancer was 2.45 (95% CI 2.14–2.81). The percentage of women with mixed/dense breasts decreased with age, but at a higher rate the later the women were born. Among users of postmenopausal hormone therapy, the percentage of women with mixed/dense breasts was higher than in non-users, but the patterns across birth cohorts were similar. The occurrence of mixed/dense breast at screening age decreased by a z-score unit of BMI at age 13—odds ratio (OR) 0.56 (95% CI 0.53–0.58)—and so did breast cancer risk and hazard ratio (HR) 0.92 (95% CI 0.84–1.00), but it changed to HR 1.01 (95% CI 0.93–1.11) when controlled for density. Age and BMI adjusted associations between life style factors and density were largely close to unity; physical activity OR 1.06 (95% CI 0.93–1.21); alcohol consumption OR 1.01 (95% CI 0.81–1.27); air pollution OR 0.96 (95% 0.93–1.01) per 20 μg/m3; and traffic noise OR 0.94 (95% CI 0.86–1.03) per 10 dB. Weak negative associations were seen for diabetes OR 0.61 (95% CI 0.40–0.92) and cigarette smoking OR 0.86 (95% CI 0.75–0.99), and a positive association was found with hormone therapy OR 1.24 (95% 1.14–1.35). Conclusion: Our data indicate that breast tissue in middle-aged women is highly dependent on childhood body constitution while adult life-style plays a modest role, underlying the need for a long-term perspective in primary prevention of breast cancer.
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Affiliation(s)
- Elsebeth Lynge
- Nykøbing Falster Hospital, University of Copenhagen, Ejegodvej 63, DK-4800 Nykøbing Falster, Denmark
- Correspondence: ; Tel.: +45-2042-1863
| | - Ilse Vejborg
- Radiology Clinic, Copenhagen University Hospital, Rigshospitalet, DK-2100 København Ø, Denmark;
| | - Zorana Andersen
- Department of Public Health, University of Copenhagen, DK-1014 København K, Denmark; (Z.A.); (M.v.E.-C.); (G.N.)
| | - My von Euler-Chelpin
- Department of Public Health, University of Copenhagen, DK-1014 København K, Denmark; (Z.A.); (M.v.E.-C.); (G.N.)
| | - George Napolitano
- Department of Public Health, University of Copenhagen, DK-1014 København K, Denmark; (Z.A.); (M.v.E.-C.); (G.N.)
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19
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White AJ, Weinberg CR, O'Meara ES, Sandler DP, Sprague BL. Airborne metals and polycyclic aromatic hydrocarbons in relation to mammographic breast density. Breast Cancer Res 2019; 21:24. [PMID: 30760301 PMCID: PMC6373138 DOI: 10.1186/s13058-019-1110-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 01/25/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Breast density is strongly related to breast cancer. Identifying associations between environmental exposures and density may elucidate relationships with breast cancer. Metals and polycyclic aromatic hydrocarbons (PAHs) may influence breast density via oxidative stress or endocrine disruption. METHODS Study participants (n = 222,581) underwent a screening mammogram in 2011 at a radiology facility in the Breast Cancer Surveillance Consortium. Zip code residential levels of airborne PAHs and metals (arsenic, cadmium, chromium, cobalt, lead, manganese, mercury, nickel, and selenium) were assessed using the 2011 EPA National Air Toxics Assessment. Breast density was measured using the Breast Imaging-Reporting and Data System (BI-RADS) lexicon. Logistic regression was used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CI) for the individual air toxics and dense breasts (BI-RADS 3 or 4). Weighted quantile sum (WQS) regression was used to model the association between the air toxic mixture and density. RESULTS Higher residential levels of arsenic, cobalt, lead, manganese, nickel, or PAHs were individually associated with breast density. Comparing the highest to the lowest quartile, higher odds of having dense breasts were observed for cobalt (OR = 1.60, 95% CI 1.56-1.64) and lead (OR = 1.56, 95% CI 1.52-1.64). Associations were stronger for premenopausal women. The WQS index was associated with density overall (OR = 1.22, 95% CI 1.20-1.24); the most heavily weighted air toxics were lead and cobalt. CONCLUSIONS In this first study to evaluate the association between air toxics and breast density, women living in areas with higher concentrations of lead and cobalt were more likely to have dense breasts.
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Affiliation(s)
- Alexandra J White
- Epidemiology Branch, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC, 27709-2233, USA.
| | - Clarice R Weinberg
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC, USA
| | - Ellen S O'Meara
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC, 27709-2233, USA
| | - Brian L Sprague
- Departments of Surgery and Radiology, University of Vermont, Burlington, VT, USA
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20
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Regular physical activity and mammographic density: a cohort study. Cancer Causes Control 2018; 29:1015-1025. [PMID: 30194548 PMCID: PMC6245045 DOI: 10.1007/s10552-018-1075-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 08/17/2018] [Indexed: 12/02/2022]
Abstract
Purpose Physical activity is a modifiable lifestyle risk factor in prevention of breast cancer. Mammographic density (MD) is a strong risk factor for breast cancer. We investigate the association of regular physical activity with MD. Methods For 5,703 women who participated in the Danish Diet, Cancer and Health cohort (1993–1997) and attended mammographic screening in Copenhagen (1993–2001), MD was assessed at the first screening after cohort entry. MD was defined as a binary measure equivalent to Breast Imaging Report and Data System (BI-RADS) to either mixed/dense or fatty. Participation and duration in physical activities (hours/week) and confounders were assessed by questionnaire at cohort baseline. Logistic regression was used to estimate associations [odds ratios (OR), 95% confidence intervals (CI)] between physical activities and MD. Results 56.3% of women had mixed/dense MD and 47.6% participated in sports. We found a significant positive association between participation in sports (OR 1.15; 95% CI 1.03–1.28) and do-it-yourself work (1.17; 1.05–1.31) and odds of having mixed/dense MD, which attenuated (1.08; 0.96–1.22 and 1.11; 0.98–1.25, respectively) in a fully adjusted model. No associations were found for time spent on physical activities or total metabolic equivalent of task scores with MD, in fully adjusted models. There was no effect modification of association between any physical activities and MD by obesity (BMI ≥ 30 kg/m2) and menopause status. Conclusions Physical activity is not a determinant of MD. Electronic supplementary material The online version of this article (10.1007/s10552-018-1075-3) contains supplementary material, which is available to authorized users.
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21
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Evaluation of the Danish AirGIS air pollution modeling system against measured concentrations of PM2.5, PM10, and black carbon. Environ Epidemiol 2018. [DOI: 10.1097/ee9.0000000000000014] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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22
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Azam S, Lange T, Huynh S, Aro AR, von Euler-Chelpin M, Vejborg I, Tjønneland A, Lynge E, Andersen ZJ. Hormone replacement therapy, mammographic density, and breast cancer risk: a cohort study. Cancer Causes Control 2018; 29:495-505. [PMID: 29671181 PMCID: PMC5938298 DOI: 10.1007/s10552-018-1033-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 04/13/2018] [Indexed: 01/05/2023]
Abstract
Purpose Hormone replacement therapy (HRT) use increases breast cancer risk and mammographic density (MD). We examine whether MD mediates or modifies the association of HRT with the breast cancer. Methods For the 4,501 participants in the Danish diet, cancer and health cohort (1993–1997) who attended mammographic screening in Copenhagen (1993–2001), MD (mixed/dense or fatty) was assessed at the first screening after cohort entry. HRT use was assessed by questionnaire and breast cancer diagnoses until 2012 obtained from the Danish cancer registry. The associations of HRT with MD and with breast cancer were analyzed separately using Cox’s regression. Mediation analyses were used to estimate proportion [with 95% confidence intervals (CI)] of an association between HRT and breast cancer mediated by MD. Results 2,444 (54.3%) women had mixed/dense breasts, 229 (5.4%) developed breast cancer, and 35.9% were current HRT users at enrollment. Compared to never users, current HRT use was statistically significantly associated with having mixed/dense breasts (relative risk and 95% CI 1.24; 1.14–1.35), and higher risk of breast cancer (hazard ratio 1.87; 1.40–2.48). Association between current HRT use and breast cancer risk was partially mediated by MD (percent mediated = 10%; 95% CI 4–22%). The current HRT use-related breast cancer risk was higher in women with mixed/dense (1.94; 1.37–3.87) than fatty (1.37; 0.80–2.35) breasts (p value for interaction = 0.15). Conclusions MD partially mediates some of the association between HRT and breast cancer risk. The association between HRT and breast cancer seems to be stronger in women with dense breasts.
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Affiliation(s)
- Shadi Azam
- Unit for Health Promotion, Department of Public Health, University of Southern Denmark, Niels Bohrs Vej 9, 6700, Esbjerg, Denmark.
| | - Theis Lange
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark.,Center for Statistical Science, Peking University, Beijing, China
| | - Stephanie Huynh
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark.,Department of Neuroscience, Smith College, Northampton, Massachusets, USA.,Danish Institute for Study Abroad, Vestergade 5-7, 1456, Copenhagen, Denmark
| | - Arja R Aro
- Unit for Health Promotion, Department of Public Health, University of Southern Denmark, Niels Bohrs Vej 9, 6700, Esbjerg, Denmark
| | - My von Euler-Chelpin
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark
| | - Ilse Vejborg
- Diagnostic Imaging Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
| | - Elsebeth Lynge
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark
| | - Zorana J Andersen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark
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23
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Roswall N, Andersen ZJ, von Euler-Chelpin M, Vejborg I, Lynge E, Jensen SS, Raaschou-Nielsen O, Tjønneland A, Sørensen M. Residential traffic noise and mammographic breast density in the Diet, Cancer, and Health cohort. Cancer Causes Control 2018. [PMID: 29520472 DOI: 10.1007/s10552-018-1021-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Traffic is the most important source of community noise, and it has been proposed to be associated with a range of disease outcomes, including breast cancer. As mammographic breast density (MD) is one of the strongest risk factors for developing breast cancer, the present study investigated whether there is an association between residential exposure to traffic noise and MD in a Danish cohort. METHODS We included women with reproductive and lifestyle information available from the Diet, Cancer, and Health cohort, who also participated in the Copenhagen Mammography Screening Programme (n = 5,260). Present and historical addresses from 1987 to 2011 were found in national registries, and traffic noise was modeled 5 years before mammogram. Analyses between residential traffic noise and MD were performed using logistic regression. RESULTS We found no association between residential road and railway noise exposure 5 years before mammogram, and having a mixed/dense versus a fatty mammogram, and no interaction with menopausal status, BMI, HRT use, and railway noise exposure, for analyses on road traffic noise. CONCLUSION The present study does not suggest an association between residential traffic noise exposure and subsequent MD in a cohort of middle-aged Danish women.
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Affiliation(s)
- Nina Roswall
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark.
| | - Zorana Jovanovic Andersen
- Department of Public Health, Center for Epidemiology and Screening, University of Copenhagen, Copenhagen, Denmark
| | - My von Euler-Chelpin
- Department of Public Health, Center for Epidemiology and Screening, University of Copenhagen, Copenhagen, Denmark
| | - Ilse Vejborg
- Department of Radiology, Diagnostic Imaging Centre, Copenhagen University Hospital, Copenhagen, Denmark
| | - Elsebeth Lynge
- Department of Public Health, Center for Epidemiology and Screening, University of Copenhagen, Copenhagen, Denmark
| | | | - Ole Raaschou-Nielsen
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark.,Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark
| | - Mette Sørensen
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark.,Department of natural Science and Environment, Roskilde University, Roskilde, Denmark
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24
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DuPre NC, Hart JE, Bertrand KA, Kraft P, Laden F, Tamimi RM. Residential particulate matter and distance to roadways in relation to mammographic density: results from the Nurses' Health Studies. Breast Cancer Res 2017; 19:124. [PMID: 29169389 PMCID: PMC5701365 DOI: 10.1186/s13058-017-0915-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 11/07/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND High mammographic density is a strong, well-established breast cancer risk factor. Three studies conducted in various smaller geographic settings reported inconsistent findings between air pollution and mammographic density. We assessed whether particulate matter (PM) exposures (PM2.5, PM2.5-10, and PM10) and distance to roadways were associated with mammographic density among women residing across the United States. METHODS The Nurses' Health Studies are prospective cohorts for whom a subset has screening mammograms from the 1990s (interquartile range 1990-1999). PM was estimated using spatio-temporal models linked to residential addresses. Among 3258 women (average age at mammogram 52.7 years), we performed multivariable linear regression to assess associations between square-root-transformed mammographic density and PM within 1 and 3 years before the mammogram. For linear regression estimates of PM in relation to untransformed mammographic density outcomes, bootstrapped robust standard errors are used to calculate 95% confidence intervals (CIs). Analyses were stratified by menopausal status and region of residence. RESULTS Recent PM and distance to roadways were not associated with mammographic density in premenopausal women (PM2.5 within 3 years before mammogram β = 0.05, 95% CI -0.16, 0.27; PM2.5-10 β = 0, 95%, CI -0.15, 0.16; PM10 β = 0.02, 95% CI -0.10, 0.13) and postmenopausal women (PM2.5 within 3 years before mammogram β = -0.05, 95% CI -0.27, 0.17; PM2.5-10 β = -0.01, 95% CI -0.16, 0.14; PM10 β = -0.02, 95% CI -0.13, 0.09). Largely null associations were observed within regions. Suggestive associations were observed among postmenopausal women in the Northeast (n = 745), where a 10-μg/m3 increase in PM2.5 within 3 years before the mammogram was associated with 3.4 percentage points higher percent mammographic density (95% CI -0.5, 7.3). CONCLUSIONS These findings do not support that recent PM or roadway exposures influence mammographic density. Although PM was largely not associated with mammographic density, we cannot rule out the role of PM during earlier exposure time windows and possible associations among northeastern postmenopausal women.
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Affiliation(s)
- Natalie C. DuPre
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA USA
| | - Jaime E. Hart
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA USA
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | | | - Peter Kraft
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Francine Laden
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA USA
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Rulla M. Tamimi
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA USA
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25
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Andersen ZJ, Stafoggia M, Weinmayr G, Pedersen M, Galassi C, Jørgensen JT, Oudin A, Forsberg B, Olsson D, Oftedal B, Aasvang GM, Aamodt G, Pyko A, Pershagen G, Korek M, De Faire U, Pedersen NL, Östenson CG, Fratiglioni L, Eriksen KT, Tjønneland A, Peeters PH, Bueno-de-Mesquita B, Plusquin M, Key TJ, Jaensch A, Nagel G, Lang A, Wang M, Tsai MY, Fournier A, Boutron-Ruault MC, Baglietto L, Grioni S, Marcon A, Krogh V, Ricceri F, Sacerdote C, Migliore E, Tamayo-Uria I, Amiano P, Dorronsoro M, Vermeulen R, Sokhi R, Keuken M, de Hoogh K, Beelen R, Vineis P, Cesaroni G, Brunekreef B, Hoek G, Raaschou-Nielsen O. Long-Term Exposure to Ambient Air Pollution and Incidence of Postmenopausal Breast Cancer in 15 European Cohorts within the ESCAPE Project. ENVIRONMENTAL HEALTH PERSPECTIVES 2017; 125:107005. [PMID: 29033383 PMCID: PMC5933325 DOI: 10.1289/ehp1742] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 08/04/2017] [Accepted: 08/12/2017] [Indexed: 05/23/2023]
Abstract
BACKGROUND Epidemiological evidence on the association between ambient air pollution and breast cancer risk is inconsistent. OBJECTIVE We examined the association between long-term exposure to ambient air pollution and incidence of postmenopausal breast cancer in European women. METHODS In 15 cohorts from nine European countries, individual estimates of air pollution levels at the residence were estimated by standardized land-use regression models developed within the European Study of Cohorts for Air Pollution Effects (ESCAPE) and Transport related Air Pollution and Health impacts – Integrated Methodologies for Assessing Particulate Matter (TRANSPHORM) projects: particulate matter (PM) ≤2.5μm, ≤10μm, and 2.5–10μm in diameter (PM2.5, PM10, and PMcoarse, respectively); PM2.5 absorbance; nitrogen oxides (NO2 and NOx); traffic intensity; and elemental composition of PM. We estimated cohort-specific associations between breast cancer and air pollutants using Cox regression models, adjusting for major lifestyle risk factors, and pooled cohort-specific estimates using random-effects meta-analyses. RESULTS Of 74,750 postmenopausal women included in the study, 3,612 developed breast cancer during 991,353 person-years of follow-up. We found positive and statistically insignificant associations between breast cancer and PM2.5 {hazard ratio (HR)=1.08 [95% confidence interval (CI): 0.77, 1.51] per 5 μg/m3}, PM10 [1.07 (95% CI: 0.89, 1.30) per 10 μg/m3], PMcoarse[1.20 (95% CI: 0.96, 1.49 per 5 μg/m3], and NO2 [1.02 (95% CI: 0.98, 1.07 per 10 μg/m3], and a statistically significant association with NOx [1.04 (95% CI: 1.00, 1.08) per 20 μg/m3, p=0.04]. CONCLUSIONS We found suggestive evidence of an association between ambient air pollution and incidence of postmenopausal breast cancer in European women. https://doi.org/10.1289/EHP1742.
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Affiliation(s)
- Zorana J Andersen
- Centre for Epidemiology and Screening, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Massimo Stafoggia
- Department of Epidemiology, Lazio Regional Health Service, Local Health Unit Azienda Sanitaria Locale Roma 1 (ASL RM1), Rome, Italy
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Marie Pedersen
- Centre for Epidemiology and Screening, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- The Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Claudia Galassi
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and Center for Cancer Prevention (CPO), Turin, Italy
| | - Jeanette T Jørgensen
- Centre for Epidemiology and Screening, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anna Oudin
- Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Bertil Forsberg
- Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - David Olsson
- Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | | | - Geir Aamodt
- Norwegian Institute of Public Health, Oslo, Norway
| | - Andrei Pyko
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Michal Korek
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Ulf De Faire
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Nancy L Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Claes-Göran Östenson
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology Care Science and Society, Karolinska Institute, Stockholm, Sweden
| | | | - Anne Tjønneland
- The Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Petra H Peeters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK
| | - Bas Bueno-de-Mesquita
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK
- Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Michelle Plusquin
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK
| | - Timothy J Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Andrea Jaensch
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
- Agency for Preventive and Social Medicine, Bregenz, Austria
| | - Alois Lang
- Vorarlberg Cancer Registry, Agency for Preventive and Social Medicine (aks, Bregenz, Austria
| | - Meng Wang
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, USA
| | - Ming-Yi Tsai
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, USA
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Agnes Fournier
- Centre de recherche en Épidémiologie et Santé des Populations (CESP) "Health across Generations", Institut national de la santé et de la recherche médicale (Inserm), Université Paris-Saclay, Villejuif, France
- Institut Gustave Roussy, Villejuif, France
| | - Marie-Christine Boutron-Ruault
- Centre de recherche en Épidémiologie et Santé des Populations (CESP) "Health across Generations", Institut national de la santé et de la recherche médicale (Inserm), Université Paris-Saclay, Villejuif, France
- Institut Gustave Roussy, Villejuif, France
| | - Laura Baglietto
- Centre de recherche en Épidémiologie et Santé des Populations (CESP) "Health across Generations", Institut national de la santé et de la recherche médicale (Inserm), Université Paris-Saclay, Villejuif, France
- Institut Gustave Roussy, Villejuif, France
| | - Sara Grioni
- Epidemiology and Prevention Unit, Department of Preventive and Predictive Medicine, Fondazione Istituto di ricovero e cura a carattere scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandro Marcon
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Vittorio Krogh
- Epidemiology and Prevention Unit, Department of Preventive and Predictive Medicine, Fondazione Istituto di ricovero e cura a carattere scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Fulvio Ricceri
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and Center for Cancer Prevention (CPO), Turin, Italy
- Unit of Epidemiology, Regional Health Service Azienda Sanitaria Locale Torino 3 (ASL TO3), Grugliasco, Italy
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and Center for Cancer Prevention (CPO), Turin, Italy
| | - Enrica Migliore
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and Center for Cancer Prevention (CPO), Turin, Italy
| | - Ibon Tamayo-Uria
- ISGlobal Institute de Salut Global Barcelona, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Madrid, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Pilar Amiano
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Madrid, Spain
- Public Health Department of Gipuzkoa, BioDonostia Research Institute, San Sebastian, Spain
| | - Miren Dorronsoro
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Madrid, Spain
- Public Health Department of Gipuzkoa, BioDonostia Research Institute, San Sebastian, Spain
| | - Roel Vermeulen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
| | - Ranjeet Sokhi
- Centre for Atmospheric and Instrumentation Research, University of Hertfordshire, Hatfield, UK
| | - Menno Keuken
- Netherlands Organization for Applied Scientific Research, Utrecht, Netherlands
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Rob Beelen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
- National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Paolo Vineis
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK
- Molecular and Epidemiology Unit, Human Genetics Foundation (HuGeF), Torino, Italy
| | - Giulia Cesaroni
- Department of Epidemiology, Lazio Regional Health Service, Local Health Unit Azienda Sanitaria Locale Roma 1 (ASL RM1), Rome, Italy
| | - Bert Brunekreef
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Madrid, Spain
| | - Gerard Hoek
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
| | - Ole Raaschou-Nielsen
- The Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
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Association between air pollution and mammographic breast density in the Breast Cancer Surveilance Consortium. Breast Cancer Res 2017; 19:36. [PMID: 28381271 PMCID: PMC5382391 DOI: 10.1186/s13058-017-0828-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 02/28/2017] [Indexed: 11/25/2022] Open
Abstract
Background Mammographic breast density is a well-established strong risk factor for breast cancer. The environmental contributors to geographic variation in breast density in urban and rural areas are poorly understood. We examined the association between breast density and exposure to ambient air pollutants (particulate matter <2.5 μm in diameter (PM2.5) and ozone (O3)) in a large population-based screening registry. Methods Participants included women undergoing mammography screening at imaging facilities within the Breast Cancer Surveillance Consortium (2001–2009). We included women aged ≥40 years with known residential zip codes before the index mammogram (n = 279,967). Breast density was assessed using the American College of Radiology’s Breast Imaging-Reporting and Data System (BI-RADS) four-category breast density classification. PM2.5 and O3 estimates for grids across the USA (2001–2008) were obtained from the US Environmental Protection Agency Hierarchical Bayesian Model (HBM). For the majority of women (94%), these estimates were available for the year preceding the mammogram date. Association between exposure to air pollutants and density was estimated using polytomous logistic regression, adjusting for potential confounders. Results Women with extremely dense breasts had higher mean PM2.5 and lower O3 exposures than women with fatty breasts (8.97 vs. 8.66 ug/m3 and 33.70 vs. 35.82 parts per billion (ppb), respectively). In regression analysis, women with heterogeneously dense vs. scattered fibroglandular breasts were more likely to have higher exposure to PM2.5 (fourth vs. first quartile odds ratio (OR) = 1.19, 95% confidence interval (CI) 1.16 − 1.23). Women with extremely dense vs. scattered fibroglandular breasts were less likely to have higher levels of ozone exposure (fourth vs. first quartile OR = 0.80, 95% CI 0.73–0.87). Conclusion Exposure to PM2.5 and O3 may in part explain geographical variation in mammographic density. Further studies are warranted to determine the causal nature of these associations.
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Jacobsen KK, Lynge E, Vejborg I, Tjønneland A, von Euler-Chelpin M, Andersen ZJ. Cigarette smoking and mammographic density in the Danish Diet, Cancer and Health cohort. Cancer Causes Control 2015; 27:271-80. [PMID: 26645565 DOI: 10.1007/s10552-015-0704-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 11/26/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Smoking before first childbirth increases breast cancer risk, but the biological mechanism remains unknown and may involve mammographic density (MD), one of the strongest biomarkers of breast cancer risk. We aimed to examine whether active smoking and passive smoking were associated with MD. METHODS For the 5,356 women (4,489 postmenopausal) from the Danish Diet, Cancer and Health cohort (1993-1997) who attended mammographic screening in Copenhagen (1993-2001), we used MD (mixed/dense or fatty) assessed at the first screening after cohort entry. Active smoking (status, duration, and intensity) and passive smoking were assessed at cohort baseline (1993-1997) via questionnaire, together with other breast cancer risk factors. Logistic regression was used to estimate associations (odds ratios, 95 % confidence intervals) between smoking and MD, adjusting for confounders. RESULTS Two thousand and twenty-six (56.5 %) women had mixed/dense MD, 2,214 (41.4 %) were current, and 1,175 (21.9 %) former smokers. Current smokers had significantly lower odds (0.86, 0.75-0.99) of having mixed/dense MD compared to never smokers, while former smoking was not associated with MD. Inverse association between smoking and MD was strongest in women who initiated smoking before age of 16 years (0.79, 0.64-0.96), smoked ≥15 cigarettes/day (0.83, 0.71-0.98), smoked ≥5 pack-years (0.62, 0.43-0.89), smoked >30 years (0.86, 0.75-0.99), and smoked ≥11 years before first childbirth (0.70, 0.51-0.96). Association between smoking and MD diminished after smoking cessation, with increased odds of having mixed/dense breasts in women who quit smoking >20 years ago as compared to current smokers (1.37, 1.01-1.67). There was no association between passive smoking and MD. CONCLUSIONS We found an inverse association between active smoking and MD.
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Affiliation(s)
- Katja Kemp Jacobsen
- Department of Public Health, Center for Epidemiology and Screening, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark. .,Department of Technology, Faculty of Health and Technology, Metropolitan University College, Copenhagen N, Denmark.
| | - Elsebeth Lynge
- Department of Public Health, Center for Epidemiology and Screening, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark
| | - Ilse Vejborg
- Diagnostic Imaging Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen K, Denmark
| | - Anne Tjønneland
- Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen K, Denmark
| | - My von Euler-Chelpin
- Department of Public Health, Center for Epidemiology and Screening, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark
| | - Zorana J Andersen
- Department of Public Health, Center for Epidemiology and Screening, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark
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