Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
Cancer Epidemiol Biomarkers Prev. 2019 Apr;28(4):751-759. doi: 10.1158/1055-9965.EPI-18-0803. Epub 2019 Jan 15.
Although particulate matter (PM) has not been consistently associated with breast cancer risk, two studies have reported harmful associations for breast cancer survival. We examined PM exposures and breast cancer survival in two U.S.-based prospective cohort studies.
The Nurses' Health Study (NHS) and NHSII are cohorts with detailed data on medical history, lifestyle factors, and causes of death. Women with Stage I-III breast cancer ( = 8,936) were followed through June 2014. Residential PM was estimated using spatio-temporal models. We performed Cox regression to estimate hazard ratios (HR) of breast cancer-specific mortality and all-cause mortality for 10 μg/m increases in post-diagnosis PM.
There were 1,211 breast cancer-specific deaths. Overall, PM was not associated with breast cancer-specific mortality [PM: HR, 1.09; 95% confidence interval (CI), 0.87-1.36; PM: HR, 1.03; 95% CI, 0.85-1.24; PM: HR, 1.05; 95% CI, 0.89-1.24], but was associated with modest increases in all-cause mortality (PM: HR, 1.12; 95% CI, 0.96-1.30; PM: HR, 1.12; 95% CI, 1.00-1.24; PM: HR, 1.09; 95% CI, 1.01-1.18). However, among participants with Stage I disease, PM was associated with higher breast cancer-specific mortality (HR, 1.64; 95% CI, 1.11-2.43).
PM was not associated with breast cancer-specific death overall; however, higher PM was associated with all-cause mortality. Higher PM was associated with higher breast cancer-specific mortality among patients with Stage I breast cancer even after adjustment.
Studies on ambient PM and breast cancer survival demonstrate that PM may have broader health effects than previously recognized and warrants further research on breast tumor progression.
尽管颗粒物（PM）与乳腺癌风险之间的关联并不一致，但有两项研究报告称其对乳腺癌的生存存在有害影响。我们在美国的两项前瞻性队列研究中检查了 PM 暴露与乳腺癌生存之间的关系。
护士健康研究（NHS）和 NHSII 是两组队列，其中包含有关病史、生活方式因素和死因的详细数据。纳入患有 I-III 期乳腺癌的女性（=8936 人），并随访至 2014 年 6 月。使用时空模型来估算居住地 PM。我们采用 Cox 回归模型来估算诊断后 PM 每增加 10μg/m3 时乳腺癌特异性死亡率和全因死亡率的危险比（HR）。
共发生 1211 例乳腺癌特异性死亡。总体而言，PM 与乳腺癌特异性死亡率无关联[PM：HR，1.09；95%置信区间（CI），0.87-1.36；PM：HR，1.03；95% CI，0.85-1.24；PM：HR，1.05；95% CI，0.89-1.24]，但与全因死亡率的适度增加有关（PM：HR，1.12；95% CI，0.96-1.30；PM：HR，1.12；95% CI，1.00-1.24；PM：HR，1.09；95% CI，1.01-1.18）。然而，在患有 I 期疾病的患者中，PM 与较高的乳腺癌特异性死亡率相关（HR，1.64；95% CI，1.11-2.43）。
总体而言，PM 与乳腺癌特异性死亡无关；然而，PM 水平较高与全因死亡率相关。即使在调整了其他因素后，PM 水平较高与 I 期乳腺癌患者的乳腺癌特异性死亡率升高相关。
有关环境 PM 和乳腺癌生存的研究表明，PM 可能对健康的影响比之前认为的更为广泛，因此需要进一步研究 PM 对乳腺癌肿瘤进展的影响。
