Environment and Breast Cancer: Science Review
	Ten-year mortality study of the population involved in the Seveso incident in 1976
	Bertazzi, P. A., Zocchetti, C., Pesatori, A. C., Guercilena, S., Sanarico, M., Radice, L. American Journal of Epidemiology. 1989. 129:6, 1187-200.
	 Topic area
Environmental pollutant - Dioxin, TCDD
Environmental pollutant - Dioxin, TCDD
	 Study design
Other: Cohort mortality follow up.
Other: Cohort mortality follow up.
	 Funding agency
Other: Government of the Region of Lombardy, Itali
Other: Government of the Region of Lombardy, Itali
Study Participants
	 Menopausal Status
	
Post menopausal
 The menopausal status of women included in this study is listed here.
	Pre menopausalPost menopausal
	Number  in Cohort  
Cohort: 30,703 males and females in zones A, B, R compared with 167,391 referent cohort in surrounding area
Cohort: 30,703 males and females in zones A, B, R compared with 167,391 referent cohort in surrounding area
	 Cohort participation rate
99% vital status ascertainment
99% vital status ascertainment
	 Participant selection: Inclusion and exclusion criteria
	
 Criteria used to select participants in the study.
	Residence in region surrounding Seveso, Italy, between December 1976 and 1986 and age 20-74 years at follow-up.
Exposure Investigated
	 Exposures investigated
Residence in zones A, B, R in or near Seveso, Italy, after contamination by 2,3,7,8 tetrachlorodibenzodioxin (TCDD) from an industrial accident July 10, 1076. Residence determined by population registry. Exposure based on residence at the date of the ac
Residence in zones A, B, R in or near Seveso, Italy, after contamination by 2,3,7,8 tetrachlorodibenzodioxin (TCDD) from an industrial accident July 10, 1076. Residence determined by population registry. Exposure based on residence at the date of the ac
	 How exposure was measured
GIS/geographic location
GIS/geographic location
	 Exposure assessment comment
People resident elsewhere who were in accident area at time of accident and those resident in accident area, but elsewhere at the time, were not identified. The zones represent a range of exposure, combining higher and more moderate exposures. The validity of the zones as representing a gradient of exposure has been questioned.
People resident elsewhere who were in accident area at time of accident and those resident in accident area, but elsewhere at the time, were not identified. The zones represent a range of exposure, combining higher and more moderate exposures. The validity of the zones as representing a gradient of exposure has been questioned.
Statistical Analysis
	 Breast cancer outcome investigated
Mortality from breast cancer
Mortality from breast cancer
	 Ethnic groups with separate analysis
	
 If this study provided a separate analysis by ethnic or racial group, the groups are listed here.
	No
	 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, gender
	 Genetic characterization included
	
 If the study analyzed relationships between environmental factors and inherited genetic variations, this field will be marked “Yes.” “No”, if not.
	No
	 Description of major analysis
Poisson regression
Poisson regression
	 Strength of associations reported
1976-1986
Zone A females: 1 breast cancer death; RR 1.06 (0.1-7.5)
Zone B females: 5 breast cancer deaths; RR 0.87 (0.4-2.1)
Zone R females: 28 breast cancer deaths; RR 0.64 (0.4-0.9)
1976-1986
Zone A females: 1 breast cancer death; RR 1.06 (0.1-7.5)
Zone B females: 5 breast cancer deaths; RR 0.87 (0.4-2.1)
Zone R females: 28 breast cancer deaths; RR 0.64 (0.4-0.9)
	 Results Comments
Because dioxin is anti-estrogenic, reduced breast cancer risk was hypothesized. Mortality is an insensitive indicator for breast cancer.
Because dioxin is anti-estrogenic, reduced breast cancer risk was hypothesized. Mortality is an insensitive indicator for breast cancer.
	 Author address
Institute of Occupational Health, Clinica L. Devoto, Universita' degli Studi, Milano, Italy.
Institute of Occupational Health, Clinica L. Devoto, Universita' degli Studi, Milano, Italy.