Travis Ruth C, Balkwill Angela, Fensom Georgina K, Appleby Paul N, Reeves Gillian K, Wang Xiao-Si, Roddam Andrew W, Gathani Toral, Peto Richard, Green Jane, Key Timothy J, Beral Valerie
Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK (RCT, AB, GKF, PNA, GKR, XSW, AWR, TG, JG, TJK, VB); Worldwide Epidemiology, GlaxoSmithKline R&D, Uxbridge, UK (AWR); Department of Oncoplastic Breast Surgery, Oxford University Hospitals NHS Trust, Oxford, UK (TG); Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK (RP)
Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK (RCT, AB, GKF, PNA, GKR, XSW, AWR, TG, JG, TJK, VB); Worldwide Epidemiology, GlaxoSmithKline R&D, Uxbridge, UK (AWR); Department of Oncoplastic Breast Surgery, Oxford University Hospitals NHS Trust, Oxford, UK (TG); Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK (RP).
J Natl Cancer Inst. 2016 Oct 6;108(12). doi: 10.1093/jnci/djw169. Print 2016 Dec.
It has been proposed that night shift work could increase breast cancer incidence. A 2007 World Health Organization review concluded, mainly from animal evidence, that shift work involving circadian disruption is probably carcinogenic to humans. We therefore aimed to generate prospective epidemiological evidence on night shift work and breast cancer incidence.
Overall, 522 246 Million Women Study, 22 559 EPIC-Oxford, and 251 045 UK Biobank participants answered questions on shift work and were followed for incident cancer. Cox regression yielded multivariable-adjusted breast cancer incidence rate ratios (RRs) and 95% confidence intervals (CIs) for night shift work vs no night shift work, and likelihood ratio tests for interaction were used to assess heterogeneity. Our meta-analyses combined these and relative risks from the seven previously published prospective studies (1.4 million women in total), using inverse-variance weighted averages of the study-specific log RRs.
In the Million Women Study, EPIC-Oxford, and UK Biobank, respectively, 673, 28, and 67 women who reported night shift work developed breast cancer, and the RRs for any vs no night shift work were 1.00 (95% CI = 0.92 to 1.08), 1.07 (95% CI = 0.71 to 1.62), and 0.78 (95% CI = 0.61 to 1.00). In the Million Women Study, the RR for 20 or more years of night shift work was 1.00 (95% CI = 0.81 to 1.23), with no statistically significant heterogeneity by sleep patterns or breast cancer risk factors. Our meta-analysis of all 10 prospective studies included 4660 breast cancers in women reporting night shift work; compared with other women, the combined relative risks were 0.99 (95% CI = 0.95 to 1.03) for any night shift work, 1.01 (95% CI = 0.93 to 1.10) for 20 or more years of night shift work, and 1.00 (95% CI = 0.87 to 1.14) for 30 or more years.
The totality of the prospective evidence shows that night shift work, including long-term shift work, has little or no effect on breast cancer incidence.
有人提出夜班工作可能会增加乳腺癌发病率。2007年世界卫生组织的一项综述主要基于动物证据得出结论，即涉及昼夜节律紊乱的轮班工作可能对人类具有致癌性。因此，我们旨在得出关于夜班工作与乳腺癌发病率的前瞻性流行病学证据。
总体而言，522246名“百万女性研究”参与者、22559名“欧洲癌症与营养前瞻性调查——牛津队列”参与者以及251045名英国生物银行参与者回答了有关轮班工作的问题，并对其进行癌症发病随访。Cox回归得出了夜班工作与无夜班工作相比的多变量调整后的乳腺癌发病率比值比（RRs）及95%置信区间（CIs），并使用交互作用似然比检验来评估异质性。我们的荟萃分析将这些数据与之前发表的七项前瞻性研究（总共140万名女性）中的相对风险相结合，采用各研究特定对数RRs的逆方差加权平均值。
在“百万女性研究”、“欧洲癌症与营养前瞻性调查——牛津队列”和英国生物银行中，分别有673名、28名和67名报告有夜班工作的女性患乳腺癌，有夜班工作与无夜班工作相比的RRs分别为1.00（95%CI = 0.92至1.08）、1.07（95%CI = 0.71至1.62）和0.78（95%CI = 0.61至1.00）。在“百万女性研究”中，从事20年或更长时间夜班工作的RR为1.00（95%CI = 0.81至1.23），按睡眠模式或乳腺癌风险因素划分无统计学显著异质性。我们对所有10项前瞻性研究的荟萃分析纳入了4660例报告有夜班工作的女性乳腺癌病例；与其他女性相比，任何夜班工作的综合相对风险为0.99（95%CI = 0.95至1.03），从事20年或更长时间夜班工作的为1.01（95%CI = 0.93至1.10），从事30年或更长时间夜班工作的为1.00（95%CI = 0.87至1.14）。
前瞻性证据总体表明，夜班工作，包括长期轮班工作，对乳腺癌发病率几乎没有影响。
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