Epidemiology Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Slone Epidemiology Center at Boston University, Boston, MA, USA.
Environ Res. 2020 Jul;186:109516. doi: 10.1016/j.envres.2020.109516. Epub 2020 Apr 13.
Dioxins are persistent organic pollutants generated from industrial combustion processes such as waste incineration. To date, results from epidemiologic studies of dioxin exposure and breast cancer risk have been mixed.
To prospectively examine the association between ambient dioxin exposure using a nationwide spatial database of industrial dioxin-emitting facilities and invasive breast cancer risk in the Nurses' Health Study II (NHSII).
NHSII includes female registered nurses in the US who have completed self-administered biennial questionnaires since 1989. Incident invasive breast cancer diagnoses were self-reported and confirmed by medical record review. Dioxin exposure was estimated based on residential proximity, duration of residence, and emissions from facilities located within 3, 5, and 10 km around geocoded residential addresses updated throughout follow-up. Cox regression models adjusted for breast cancer risk factors were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs).
From 1989 to 2013, 3840 invasive breast cancer cases occurred among 112,397 participants. There was no association between residential proximity to any dioxin facilities (all facilities combined) and breast cancer risk overall. However, women who resided within 10 km of any municipal solid waste incinerator (MSWI) compared to none had increased breast cancer risk (adjusted HR = 1.15, 95% CI: 1.03, 1.28), with stronger associations noted for women who lived within 5 km (adjusted HR = 1.25, 95% CI: 1.04, 1.52). Positive associations were also observed for longer duration of residence and higher dioxin emissions from MSWIs within 3, 5, and 10 km. There were no clear differences in patterns of association for ER + vs. ER-breast cancer or by menopausal status.
Results from this study support positive associations between dioxin exposure from MSWIs and invasive breast cancer risk.
二恶英是持久性有机污染物，由工业燃烧过程（如废物焚烧）产生。迄今为止，二恶英暴露与乳腺癌风险的流行病学研究结果喜忧参半。
使用全国性的工业二恶英排放设施空间数据库，前瞻性地研究环境中二恶英暴露与护士健康研究 II（NHSII）中浸润性乳腺癌风险之间的关系。
NHSII 包括美国的注册护士，自 1989 年以来，她们已完成了两次年度自我报告问卷。浸润性乳腺癌的诊断是通过自我报告并通过病历审查来确认的。根据居住地的接近程度、居住时间以及更新后的地理编码居住地址周围 3、5 和 10 公里范围内设施的排放量来估计二恶英暴露情况。使用 Cox 回归模型调整乳腺癌危险因素，计算风险比（HR）和 95%置信区间（CI）。
1989 年至 2013 年期间，在 112397 名参与者中，有 3840 例浸润性乳腺癌病例。总的来说，居住地与任何二恶英设施（所有设施的总和）的距离与乳腺癌风险之间没有关联。然而，与没有居住地的女性相比，居住在任何城市固体废物焚烧厂（MSWI） 10 公里范围内的女性乳腺癌风险增加（调整后的 HR=1.15，95%CI：1.03，1.28），居住在 5 公里范围内的女性的关联更强（调整后的 HR=1.25，95%CI：1.04，1.52）。在 3、5 和 10 公里范围内，居住时间较长、MSWI 的二恶英排放量较高也与阳性关联有关。ER+和 ER-乳腺癌或绝经状态的关联模式没有明显差异。
本研究结果支持 MSWI 中二恶英暴露与浸润性乳腺癌风险之间存在正相关关系。
