Environment and Breast Cancer: Science Review

Evidence From Humans
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Risk of female breast cancer and serum concentrations of organochlorine pesticides and polychlorinated biphenyls: A case-control study in Tunisia
Arrebola, J. P., Belhassen, H., Artacho-Cordon, F., Ghali, R., Ghorbel, H., Boussen, H., Perez-Carrascosa, F. M., Exposito, J., Hedhili, A., Olea, N. Sci Total Environ. 2015. 520, 106-13.
Topic area
Environmental pollutant - Persistent organic pollutants Organochlorine pesti
Study design
Hospital based case-control
Funding agency
CIBER de Epidemiología and Junta de Andalucía Mi
Study Participants
Menopausal Status
The menopausal status of women included in this study is listed here.
No analysis based on menopausal status
Number of Controls
Controls: 54
Participant selection: Inclusion and exclusion criteria
Criteria used to select participants in the study.
69 cases were recruited from breast cancer patients who were 18 years and over and had been admitted to two hospitals for mastectomy, tumorectomy, or chemotherapy from two main specialty hospitals in Tunisia in 2012. 54 controls were randomly selected from healthy female hospital visitors, hospital staff, and blood donors aged 18 years and over (56 controls were selected, but 54 were included in the final analysis). Cases and controls were asked to give informed consent and complete a questionnaire. Subjects were excluded if they had a previous history of cancer or evidence of distant metastasis at diagnosis.
Comment about participation selection
Cases and controls differed significantly in their occupational class (homemaker, manual worker, non-manual worker), education, residence (urban vs. rural), and menopausal status. Healthy visitors, hospital staff and blood donors may not be representative of the source population for cases.
Exposure Investigated
Exposures investigated
Blood was collected at time of diagnosis (before treatment) and measured for p,p′-DDE, HCB, β-HCH, α-Endosulfan, Heptachlor, PCB 138, PCB 153, PCB 180
Exposure assessment comment
β-HCH and α-Endosulfan were detected with low frequency and were analyzed both as continuous variables and dichotomous ones (LOD). Other POPs were analyzed both as continuous and categorical variables (based on tertiles of concentration).
Breast cancer outcome investigated
Primary incident breast cancer
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, BMI, occupational class, residence, education, accumulated lactation time, menopausal status, family history of breast cancer, total serum lipids.
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
Wet-basis models:
β-HCH, per ng/mL increase: aOR 1.16 (95% CI 1.05-1.30)
β-HCH, >LOD vs. p,p'-DDE, per ng/dL increase: aOR 1.72 (95% CI: 1.11-3.13)
p,p'-DDE, 2nd tertile vs. 1st tertile: aOR 7.79 (95% CI 2.04-35.31)
p,p'-DDE, 3rd tertile vs. 1st tertile: aOR 7.08 (95% CI 1.15-38.47)
heptachlor, α=0.100 level, per ng/mL increase: aOR 3.24 (95% CI 0.92-12.18)
PCB 138, 3rd tertile vs. 1st tertile: aOR 4.40 (95% CI 0.90-18.88)
PCB 153, 3rd tertile vs. 1st tertile: aOR 1.23 (95% CI 0.29-5.31)
PCB 180, 3rd tertile vs. 1st tertile: aOR 1.62 (95% CI 0.37-7.32)

Lipid-basis models:
β-HCH, per mg/g increase: aOR 1.10 (95% CI: 1.03-1.18)
β-HCH, >LOD vs. p,p'-DDE, per ng/g increase: aOR 1.37 (95% CI 1.07-1.94)
p,p'-DDE, 2nd tertile vs. 1st tertile: aOR 6.26 (95% CI 1.62-28.33)
p,p'-DDE, 3rd tertile vs. 1st tertile: aOR 9.65 (95% CI 1.81-63.33)
heptachlor, α=0.100 level, per mg/g increase: aOR 2.87 (95% CI 0.93-10.62)
PCB 138, 3rd tertile vs. 1st tertile: aOR 2.99 (95% CI 0.75-13.42)
PCB 153, 3rd tertile vs. 1st tertile: aOR 1.25 (95% CI 0.31-5.11)
PCB 180, 3rd tertile vs. 1st tertile: aOR 1.11 (95% CI 0.26-4.64)

After including β-HCH, heptachlor, and p,p'-DDE in a single model and adjusting for covariates, only β-HCH remained significant (wet-basis model: aOR 1.18; 95% CI 1.05-1.34).
Author address
Radiation Oncology Department, Virgen de las Nieves University Hospital, Granada, Spain; San Cecilio University Hospital, Instituto de Investigacion Biosanitaria ibs. Granada, University of Granada, CIBERESP, Spain. Electronic address: jparrebola@ugr.es.
Reviewers Comments
The authors note that serum is not necessarily the best matrix for analysis of these compounds (adipose tissue is one alternative). They also describe the need to assess biomarkers of combined effects to capture the synergic and/or antagonistic effects of a mixture of chemicals.