Environment and Breast Cancer: Science Review

Evidence From Humans
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Breast cancer and urinary biomarkers of polycyclic aromatic hydrocarbon and oxidative stress in the Shanghai Women's Health Study
Lee, K. H., Shu, X. O., Gao, Y. T., Ji, B. T., Yang, G., Blair, A., Rothman, N., Zheng, W., Chow, W. H., Kang, D. Cancer Epidemiol Biomarkers Prev. 2010. 19:3, 877-83.
Topic area
Environmental pollutant - PAHs
Study design
Nested case-control
Funding agency
Korean Ministry of Education, Science, & Technolog
Study Participants
Menopausal Status
The menopausal status of women included in this study is listed here.
Stratified analyses based on menopausal status (data not shown)
Number of Controls
Controls: 654
Participant selection: Inclusion and exclusion criteria
Criteria used to select participants in the study.
The Shanghai Women's Health Study is a population-based prospective cohort of 74,942 women who were recruited from seven communities of urban Shanghai from 1997-2000, between the ages of 40-70 years. In this nested case-control study, 327 cases were identified through follow-up with cohort members and linkage to the Shanghai Tumor Registry from 1997-2004. 654 controls (two per case) were selected from cohort participants without cancer at the time of case diagnosis, matched by age, sample collection date, collection time of day, antibiotic use in the past week, and menopausal status. Cases and controls without urine samples and biomarker analysis were excluded (reflected in the numbers reported here).
Comment about participation selection
The follow-up time for incident case ascertainment was relatively short (about 5-7 years), limiting the number of cases observed in this time period.
Exposure Investigated
Exposures investigated
Creatinine-adjusted urinary levels of two PAH metabolites (1-hydroxypyrene and 2-naphthol), an indicator of oxidative stress (malondialdehyde), and an indicator of DNA damage (8-hydroxy-2'-deoxyguanosine). Spot urine samples were collected at the time of
Exposure assessment comment
Adjusting PAH metabolite levels for creatinine may obscure dietary exposures to PAHs. The measure of PAH metabolites in urine may not necessarily reflect PAH exposure during the etiologic period. 76% of cases and 79% of controls reported exposure to environmental tobacco smoke, which is a source of PAHs.
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, sample collection date, antibiotic use in past week, previous cancer history, menopausal 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
1-hydroxypyrene (ref = Quartile 1):
Q2 OR 0.90 (95% CI 0.62-1.30)
Q3 OR 0.83 (95% CI 0.57-1.20)
Q4 OR 0.91 (95% CI 0.63-1.32)

2-naphthol (ref = Quartile 1)
Q2 OR 0.93 (95% CI 0.64-1.35)
Q3 OR 0.81 (95% CI 0.56-1.18)
Q4 OR 0.83 (95% CI 0.58-1.21)
Results Comments
Higher education was associated with a significantly lower risk of breast cancer, contrary to the direction of associations generally observed in the United States. Authors note no significant associations when stratifying by menopause (data not shown).
Author address
Department of Preventive Medicine, Seoul National University College of Medicine, Institute of Environmental Medicine, SNUMRC, Seoul, Korea.