Environment and Breast Cancer: Science Review

Evidence From Humans
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Evaluation of contaminated drinking water and male breast cancer at Marine Corps Base Camp Lejeune, North Carolina: a case control study
Ruckart, P. Z., Bove, F. J., Shanley, E., 3rd, Maslia, M. Environ Health. 2015. 14, 74.
Topic area
Environmental pollutant - Solvents
Study design
Other: Registry-based case control
Funding agency
Not reported
Study Participants
Menopausal Status
The menopausal status of women included in this study is listed here.
Study restricted to men
Number of Controls
Controls: 373
Cohort participation rate
Not applicable. This study was records-based.
Participant selection: Inclusion and exclusion criteria
Criteria used to select participants in the study.
Male marines born before 1969 diagnosed with or treated for cancer at a VA facility from Jan 1, 1995 to May 5, 2013 were eligible to be included in this study. 78 incident cases and 400 controls were selected from Department of Veteran’s Affairs Central Cancer Registry. Controls included men with cancers not known to be related to solvent exposure, including non-melanoma skin cancers, bone cancers, and mesothelioma of the pleura and peritoneum. Individuals were excluded if they could not be linked to the National Personnel Record Center (NPRC) military personnel files to identify exposure status.
Comment about participation selection
Authors note that most Marines do not use do no use/are not eligible for VA care. Those who do are often those with service-related disabilities and/or individuals with low income. Personnel files could not be linked for 9% of cases and 27% of controls.
Exposure Investigated
Exposures investigated
Estimated tetrachloroethylene (PCE), trichloroethylene (TCE), benzene, t-1,2 dichloroethylene (DCE), vinyl chloride, and TVOC (sum of PCE, TCE, benzene, DCE and vinyl chloride) from contaminated drinking water at Camp Lejeune, North Carolina 1950s-1985. C
How exposure was measured
Environmental sample Job history
Exposure assessment comment
Potential for exposure misclassification given some assumptions about residence: Unmarried Marines assumed to reside in barracks; unmarried officers assumed to reside in bachelors officers' quarters near their units' barracks; and married Marines assumed to reside either in off-base housing or family housing on the base -- unless they were not in family housing records and spouse's address was not in/near base -- in which case assumed they lived with their units
Breast cancer outcome investigated
Primary incident breast cancer (male)
Confounders considered
Other breast cancer risk factors, such as family history, age at first birth, and hormone replacement therapy use, that were taken into account in the study.
Age at diagnosis, race, service in Vietnam, alcoholism, thyroid disorder, endocrine/metabolic/immune disease, diabetes, obesity, cholelithiasis, diseases of male genital organs, orchitis/epididymitis, gynecomastia, osteoporosis, fractures, liver disease,
Genetic characterization included
If the study analyzed relationships between environmental factors and inherited genetic variations, this field will be marked “Yes.” “No”, if not.
Strength of associations reported
Ever v. never stationed at Camp Lejeune: aOR 1.14 (95% CI 0.65-1.97)

Cumulative exposure (compared to unexposed):

Low (2 cases, 7 controls): aOR 1.05 (95% CI 0.14-5.14)
High (2 cases, 8 controls): aOR 1.20 (95% CI 0.16-5.89)

Low: aOR 1.06 (95 % CI 0.50-2.13)
High: aOR 0.93 (95 % CI 0.43-1.90)

Low: aOR 1.67 (95% CI 0.82-3.30)
High (10 cases): aOR 0.57 (95% CI 0.24-1.25)

Low (1 case, 8 controls): aOR 0.56 (95% CI 0.02-3.83)
High (3 cases, 8 controls): aOR 1.50 (95% CI 0.30-6.11)

vinyl chloride
Low (2 cases, 8 controls): aOR 0.94 (95% CI 0.13-4.38)
High (2 cases, 8 controls): aOR 1.19 (95% CI 0.16-5.89)

Total VOCs (TVOC)
Low: aOR 1.18 (95% CI 0.57-2.33)
High: aOR 0.82 (95% CI 0.37-1.72)
Results Comments
"Unexposed" consisted of (1) marines who had been stationed at Camp Lejeune but classified as not exposed to contaminated drinking water and (2) marines never stationed at Camp Lejeune ORs considering monthly average exposure for each solvent category were not notably different from ORs for cumulative exposure estimates In age at onset analysis (described by authors as 'exploratory'), there was suggestive evidence that ever being stationed at Camp Lejeune was associated with earlier onset of male breast cancer (aHR 1.51; 95% CI: 0.78-2.95). Similar associations were seen for higher cumulative PCE, TCE, DCE and vinyl chloride exposure.
Author address
Agency for Toxic Substances and Disease Registry, Division of Toxicology and Human Health Sciences, Atlanta, USA. pruckart@cdc.gov. Agency for Toxic Substances and Disease Registry, Division of Toxicology and Human Health Sciences, Atlanta, USA. fbove@cdc
Reviewers Comments
xSolvent contamination in the camp's drinking water was considered high (i.e. estimated to exceed current US drinking water standards). Small number of cases and small number of highly exposed individuals contribute to unstable estimates.