Environment and Breast Cancer: Science Review

Evidence From Humans
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Indoor air pollution exposure from use of indoor stoves and fireplaces in association with breast cancer: a case-control study
White, A. J., Teitelbaum, S. L., Stellman, S. D., Beyea, J., Steck, S. E., Mordukhovich, I., McCarty, K. M., Ahn, J., Rossner, P., Jr., Santella, R. M., Gammon, M. D. Environ Health. 2014. 13:1, 108.
Topic area
Environmental pollutant - Indoor air pollution Genetic variability
Study design
Population based case-control
Funding agency
NIH, UNC Lineberger Cancer Control Education Progr
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: 1,556
Participant selection: Inclusion and exclusion criteria
Criteria used to select participants in the study.
Female residents of Nassau and Suffolk Counties (Long Island), NY, participating in the Long Island Breast Cancer Study Project, age 20 or older, English-speaking, newly diagnosed with in situ or invasive breast cancer in 1996-1997. Cases identified by regional hospital pathology laboratories. Controls had no breast cancer history and were matched by 5-year age group, identified by random-digit-dialing or Medicare records (for women 65 and older).
Comment about participation selection
In the LIBCSP, giving a blood sample was positively associated with being white, ever using alcohol, ever using HRT, ever having a mammography, and lactation history. Older women and former smokers were less likely to give blood. Blood donation was not associated with case-control status, so these differences between the total study population and the sub-population who donated blood should not bias the findings, but could affect generalizability. Tumor tissue for p53 analysis was obtained from 67% of cases.
Exposure Investigated
Exposures investigated
Self-reported use of indoor stoves/fireplaces ≥ 3 times a year at each residence on Long Island. Tumor samples were screened for p53 mutations using the Surveyor Mutation Detection Kit. PCR amplification and sequencing by capillary sequencer was used t
How exposure was measured
Questionnaire, in person Biological
Exposure assessment comment
Authors consider that because synthetic logs are meant to be used in open fireplaces, exposure to synthetic log burning may be a proxy for exposure to open fireplaces, which they note have higher PAH emissions than wood stoves. They also note that regardless of the type of fireplace, synthetic logs may emit more PAHs when burned than wood logs, though it appears that there is some conflicting data about emissions from the different types of logs. GSTs are enzymes involved in the activation and deactivation of PAH intermediates.
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.
Based on causal diagram: Age, age at menarche, history of breastfeeding, hormone therapy use, family history of breast cancer, parity, age at first birth, BMI, education, smoking history, alcohol intake, physical activity, race, religion, marital status.
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
Compared to no use of indoor/stove fireplace:
Burned synthetic logs: OR 1.42 (95% CI 1.11-1.84)
Burned wood: OR 0.93 (95% CI 0.77-1.12)
Burned coal: OR 1.28 (95% CI 0.88-1.86)
Burned gas: OR 0.86 (95% CI 0.42-1.73)

Years of exposure to synthetic log burning:
< 7 years OR 1.12 (0.68-1.82)
7-16.7 years OR 1.73 (1.11-2.70)
16.7-24.8 years OR 1.29 (0.82-2.03)
> 24.8 years OR 1.50 (0.98-2.31)
<20 years of age: OR 1.09 (95% CI 0.46-2.59)
≥20 years of age: OR 1.65 (95% CI 1.02-2.67)

Number of GST variants:
Ever burned synthetic logs + <2 GST variants OR 1.19 (95% CI 1.03-1.39)
Never used indoor stove/fireplace + ≥2 GST variants OR 1.43 (1.06-1.93)
Ever burned synthetic logs + ≥2 GST variants OR 1.71 (95% CI 1.09-2.68)
Results Comments
Authors report no heterogeneity of effect by ER/PR status (data not show) or by p53 mutation status. Authors report no effect modification by menopausal status (data not shown).
Controls participation rate
63% completed interview 46% both completed intervi
Reviewers Comments
Limitations of this study are the lack of more detailed data on frequency and duration of exposure.